舒芬太尼复合七氟醚在甲状腺手术中的应用

目的: 观察持续静脉输注舒芬太尼复合吸入七氟醚对甲状腺手术的麻醉效果。方法: 择期行全麻下甲状腺手术患者45例,ASAI～II级,18～60岁,随机分为A、B、C三组(n=15),诱导时分别给予舒芬太尼0.15、0.30、0.45 μg/kg。术中,分别持续输注舒芬太尼0.15、0.30、0.45μg·kg^-1·h^-1,复合吸入七氟醚-笑气,根据血流动力学调整七氟醚浓度,维持吸入麻醉药最低有效浓度(MAC)1.0～1.3,并计算七氟醚用量。记录气管插管前、后及术中的血流动力学变化;术;术后24h随访。结果: 舒芬太尼0.15 μg/kg剂量组血压升高者较多,0.45 μg/kg组发生低血压、需要药物支持者较多。随舒芬太尼用药量加大,七氟醚用药量减小。持续输注舒芬太尼0.45μg·kg^-1·h^-1可明显延迟自主呼吸恢复。结论: 持续静脉输注舒芬太尼0.30μg·kg^-1·h^-1复合吸入七氟醚应用于甲状腺手术,麻醉效果好,简便易行。

Sevoflurane-nitrous oxide-sufentanil anesthesia for thyroid surgery

AIM: To evaluate the effects of continuous infusion sufentanil during a nitrous oxide-sevoflurane balanced anesthesia in patients undergoing thyroid surgery, and to seek a suitable way to ensure hemodynamic stability and fast recovery for a moderately painful operation.METHODS: 45 patients, ASA physical status I or II with age ranging from 18 to 60 years, scheduled for thyroid surgery with general anesthesia were divided into three groups randomly.Patients were induced with a loading dose of sufentanil 0.15, 0.30, and 0.45 μg/kg, respectively, and continuously infused with sufentanil (0.15, 0.30, 0.45 μg·kg^-1·h^-1) throughout surgery.The sevoflurane concentration was adjusted according to conventional clinical variables, and to keep MAC 1.0-1.3.The sevoflurane vaporizer was weighed before and after anesthesia, and consumption was calculated.MAP and heart rate were recorded at different times (before and after intubation, any intervention, and the time of recovery).Recovery time, postoperative analgesia by VAS, and intraopereative awareness were evaluated.RESULTS: Adequate anesthesia was obtained in all groups.Hypertension was more frequent with the small dose sufentanil, and hypotension requiring treatment was more frequent with the large dose sufentanil. Sevoflurane concentration during surgery decreased significantly with increasing sufentanil as well as the sevoflurane consumption.The 0.45 μg·kg^-1 ·h^-1 sufentanil significantly delayed the return of spontaneous breathing.CONCLUSION: Continuous infusing sufentanil 0.30 μg·kg^-1·h^-1 is optimal to ensure hemodynamic stability, and fast recovery, combined with sevoflurane is suitable for thyroid surgery.