| 不同剂量纳布啡复合丙泊酚对宫腔镜手术患者的麻醉效果 |
| 投稿时间：2016-12-07 修订日期：2016-12-10 点此下载全文 |
| 引用本文：彭栋梁,王晓娜,杨军.不同剂量纳布啡复合丙泊酚对宫腔镜手术患者的麻醉效果[J].医学研究杂志,2018,47(7):111-115 |
| DOI：
10.11969/j.issn.1673-548X.2018.07.026 |
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| 中文摘要:目的 比较宫腔镜手术中不同剂量纳布啡复合丙泊酚的麻醉效果并探讨纳布啡的适宜剂量。方法 择期行宫腔镜手术患者120例，患者年龄35~55岁，体重指数（BMI）17.0~27.0kg/m2，美国麻醉医师协会（ASA）分级Ⅰ或Ⅱ级，随机分为4组（n=30）：纳布啡0.05mg/kg复合丙泊酚组（N1组）、纳布啡0.10mg/kg复合丙泊酚组（N2组）、纳布啡0.15mg/kg复合丙泊酚组（N3组）和单纯丙泊酚组（P组）。P组静脉注射0.9％生理盐水0.15ml/kg；N1组、N2组和N3组分别静脉注射纳布啡0.05、0.10、0.15mg/kg，均用0.9％生理盐水稀释至0.15ml/kg；注射完毕3min后，4组均静脉注射2%利多卡因2ml，再快速静脉注射丙泊酚1mg/kg （40mg/10s），之后缓慢注射（10mg/10s）丙泊酚直至睫毛反射消失、呼之无反应后开始行宫腔镜手术，随后丙泊酚以6mg （kg·h）的速率进行麻醉维持，持续输注至开始退出宫腔镜时停药。分别于患者入室时、丙泊酚推注前、丙泊酚推注毕即刻、扩宫颈时、手术结束时及麻醉苏醒时记录收缩压（SBP）、舒张压（DBP）、心率（HR）和脉搏血氧饱和度（SpO2）。记录丙泊酚诱导用量、维持用量、总用药量、总用药时间及单位时间用量。记录手术时间，苏醒时间和术中体动反应、低氧血症及心血管事件的发生情况。记录术后头晕、恶心、呕吐等不良反应发生情况和苏醒时数字疼痛分级法（NRS）评分。结果 4组手术时间、丙泊酚维持量及低血压、心动过缓、体动反应和恶心、呕吐发生率比较差异均无统计学意义（P>0.05）。4组组间血流动力学参数比较差异无统计学意义（P>0.05）。与P组比较，N2组、N3组丙泊酚诱导量、单位时间用量及NRS评分均下降（P>0.05）；N1组、N2组和N3组苏醒时间均缩短（P<0.05）。与N1组比较，N2组、N3组丙泊酚诱导量和单位时间用量均下降（P>0.05），麻醉苏醒时间缩短（P>0.05）；N3组NRS评分下降（P<0.05）。与N2组比较，N3组丙泊酚诱导用量下降（P<0.05）。与P组比较，N3组头晕发生率升高（P>0.05）。与P组、N1组、N2组比较，N3组低氧血症发生率升高（P>0.05）。结论 对于宫腔镜手术患者而言，纳布啡配伍丙泊酚的适宜剂量是0.10mg/kg。 |
| 中文关键词:纳布啡 二丙泊酚 宫腔镜 |
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| Efficiencies of Different Doses of Nalbuphine Combined with Propofol in Hysteroscopy |
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| Abstract:Objective To compare the efficacies of different doses of nalbuphine combined with propofol in hysteroscopy. Methods A total of 120 patients with (American Society of Anesthesiologists) Physical Status Classification (ASA class) Ⅰ or Ⅱ, aged 35-55 years old, with body mass index (BMI) of 17.0-27.0kg/m2, were randomly divided into four groups (n=30 each):nalbuphine with 0.05, 0.10 and 0.15mg/kg groups (group N1, group N2 and group N3) and propofol group (group P). Patients of group P received intravenous injection of normal saline 0.15ml/kg. In groups N1, N2 and N3, nalbuphine with 0.05, 0.10 and 0.15mg/kg were injected intravenously, respectively. Nalbuphine was diluted with normal saline into 0.15ml/kg. Treated with nalbuphine after three minutes, the four groups received 2ml of intravenous injection with 2% lidocaine, and then propofol was given as a fast bolus of 1mg/kg (40mg/10s), followed by a slow bolus of 1mg/kg (10mg/10s). The hysteroscope was inserted after loss of eyelash reflex or body movement, followed by an infusion of 6mg/(kg·h) until the end of hysteroscopy. Systolic blood pressure (SBP), diastolic blood pressure (DBP), heart rate (HR) and oxygen saturation (SpO2) were recorded after admission to operating room, before propofol infusion, after propofol infusion, at uterine cervical distension, at the end of surgery and when analepsia, respectively. The usage of propofol during anesthesia induction and maintenance, total usage of propofol, total using time of propofol and the consumption of propofol per hour were recoded. The operation time, recovery time and the occurrences of body movement, hypoxemia and adverse cardiovascular events were analyzed. The incidence rate of dizziness, nausea and vomiting and NRS scores were compared. Results There was no significant difference (P>0.05) in operation time, maintenance usage of propofol and the incidence rate of hypotension, bradycardia, body movement, and nausea and vomiting between the four groups. There were no differences (P>0.05) in hemodynamic parameters between the four groups. Compared with group P, the usage of propofol inducing, the consumption of propofol per hour and NRS scores were significantly decreased (P<0.05) in groups N2 and N3, and recovery time was significantly decreased (P<0.05) in groups N1, N2 and N3. Compared with group N1, propofol inducing usage, the consumption of propofol per hour and recovery time were significantly decreased (P<0.05) in groups N2 and N3, and NRS scores was significantly decreased (P<0.05) in group N3. Propofol inducing usage was lower (P<0.05) in group N3 than in group N2. The incidence of dizziness was higher (P<0.05) in group N3 than in group P. The incidence of hypoxemia was higher (P<0.05) in group N3 than in groups P, N1 and N2. Conclusion The optimum dose of nalbuphine is 0.10 mg/kg when it is combined with propofol in hysteroscopy. |
| keywords:Nalbuphine Propofol Hysteroscopy |
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