芬太尼和舒芬太尼喉罩全麻下行EBUS-TBAN术的临床观察.DOC

芬太尼和舒芬太尼喉罩全麻下行EBUS-TBAN术的临床观察 唐富东 程华春 张慧君 吕欣* 【摘要】目的 观察芬太尼或舒芬太尼喉罩全麻下行EBUS-TBAN中的安全性和可行性。方法 选择300例ASAⅠ或Ⅱ，年龄18～70岁，拟行全麻下EBUS-TBAN的患者，随机分为芬太尼组（F组）和舒芬太尼组（S组），每组150例。采用芬太尼或舒芬太尼加静脉泵注丙泊酚和琥珀酰胆碱,辅助喉罩控制呼吸的麻醉方法。记录患者入室后(T0)、插入喉罩前（T1）、插入喉罩后（T2）、气管镜入气管时（T3），第一次针吸操作时（T4）、气管镜退出气管时（T5）、拔出喉罩后1min（T6）各时间点的BP、HR、SpO2、定向力恢复时间、手术操作者满意度、麻醉医生满意度和术后不良反应发生情况。结果 T1时两组SBP、DBP、HR较T0时明显下降（P＜0.01）且S组下降幅度小于F组（P＜0.05）；T3、T4、T5时两组SBP、DBP、HR较T0时明显升高（P＜0.05或P0.01）且S组升高幅度小于F组（P＜0.05或P＜0.01）；两组麻醉医生满意度S组高于F组（P＜0.01）;两组各时间点SPO2和术后不良反应差异无统计学意义。结论 芬太尼或舒芬太尼喉罩全麻均能安全有效的运用于EBUS-TBNA，但舒芬太尼组血流动力学更加稳定，适宜作为EBUS-TBNA的常规麻醉方法。 【关键词】EBUS-TBNA；全身麻醉；舒芬太尼；芬太尼；喉罩 Clinical observation of Fentanyl and Sufentanil used in EndobronchiaUltrasound-guided Transbronchial Needle Aspiration TANG Fu-dong,CHENG Hua-chun,ZHANG hui-jun, LV Xin. Department of Anesthesiology, Shanghai Pneumology Hospital,Tongji University,School of Medicine,shanghai 200433,China 【ABSTRACT】Objective To observe the safety and feasibility of the general anesthesia which performed with fentanyl or sufentanil combined with propofol and succinylcholine in endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA）. Methods 300 ASAⅠorⅡ patients , aged 18-70yrs, undergoing EBUS-TBNA were evenly randomized into two groups: fentanyl(F) group and sufentanil(S) group. The anesthesia of Group F performed with fentanyl, propofol and succinylcholine. In Group S fentanyl were replaced by sufentanil. SBP,DBP, HR, SpO2, the recovery time of orientation, were recorded right after patient entering the operation room(T0), before (T1)and after(T2) inserted the laryngeal mask, inserted bronchoscope into the trachea(T3), the first time of transbronchial needle aspiration(T4), pull bronchoscope out of trachea(T5), 1min after pull out the laryngeal mask(T6). The satisfaction of operation and anesthesia, incidence of postoperation side effects were evaluated at the end. Results Compared with T0, SBP,DBP and HR of two groups were declined at T1（P＜0.01）, and