刘玉+章梦娜

[摘要]目的：探討纳布啡应用于双侧重睑成形术中的疗效、安全性以及不良反应。方法：选择行双侧重睑成形术就医者56例，采用随机数字表法，随机分成两组，观察组和对照组，每组28例。观察组以纳布啡复合丙泊酚缓慢静脉注射麻醉，对照组以舒芬太尼复合丙泊酚缓慢静脉注射，呼之不应、安静入睡后两组均采用1%利多卡因1mg/kg行双侧上睑局部浸润麻醉。观察记录两组就医者在入手术室静脉麻醉前（T0）、静脉麻醉后即刻（T1）、局部浸润麻醉后即刻（T2）、局部浸润麻醉后2min（T3）、局部浸润麻醉后5min（T4）、局部浸润麻醉后10min（T5）、局部浸润麻醉后30min（T6）的心率（HR）、平均动脉压（MAP）及脉搏血氧饱和度（SpO2）的变化，并记录两组就医者的镇痛效果、清醒时间以及恶心、呕吐、头晕、呼吸抑制等不良反应发生情况。结果：观察组T1～T6时刻HR、MAP、SpO2监测值与T0相比无统计学意义（P>0.05）；对照组T1～T6时刻HR、MAP监测值与T0相比无统计学意义（P>0.05），但T1～T4时刻SpO2监测值与T0相比，差异有统计学意义（P<0.05）；两组间T1～T4时刻SpO2监测值比较，差异有统计学意义（P<0.05）。两组的镇痛效果均优，组间差异无统计学意义（P>0.05）；两组患者的清醒时间分别是（6.8±2.1）min和（6.1±2.7）min，差异无统计学意义（P>0.05）；观察组呼吸抑制、恶心、呕吐、头晕发生率明显低于对照组，差异有统计学意义（P<0.05）。结论：纳布啡与丙泊酚复合静脉麻醉应用于双侧重睑成形术中，镇痛、镇静效果确切，术中血流动力学稳定，呼吸平稳，不良反应及并发症发生率低，值得在重睑成形术中广泛应用。

[关键词]纳布啡；丙泊酚；舒芬太尼；重睑成形术

[中图分类号]R622 [文献标志码]A [文章编号]1008-6455（2017）10-0026-03

Abstract： Objective To evaluate the application of nalbuphine in bilateral double eyelid surgery curative effect， safety and adverse reactions. Methods Fifty-six cases selection phase of the bilateral eyelid shaping surgery， were randomly divided into two groups， observation group and control group， 28 cases in each group. The observation group with nalbuphine combined with propofol slow intravenous injection of anesthesia， the control group with sufentanil combined with propofol slow intravenous injection. Until loss of call， the two groups were treated with 1% lidocaine 1mg/kg for bilateral upper eyelid local infiltration anesthesia. Observing and recording 2 groups heart rate（HR）， mean arterial pressure（MAP） and pulse oxygen saturation（SpO2） changes between before intravenous anesthesia（T0）， immediately after intravenous anesthesia（T1）， immediately after local infiltration anesthesia（T2）， 2 minutes after local infiltration anesthesia（T3）， 5 minutes after local infiltration anesthesia（T4）， 10 minutes after local infiltration anesthesia （T5）， 30 minutes after local infiltration anesthesia（T6）， and recording the analgesic effect ， waking time of two groups patients and the adverse reactions of two groups of patients such as nausea， vomiting， dizziness， respiratory depression. Results The HR， MAP and SpO2 in the observation group at T1 to T6 was not statistically significant compared with that of T0（P>0.05）. The HR and MAP in the control group at T1 to T6 was not statistically significant compared with that of T0（P>0.05）， but the SpO2 at T1 to T4 was statistically significant compared with that of T0（P<0.05）. The SpO2 between the two groups at T1 to T4 was statistically significant（P<0.05）. The analgesic effects of the two groups were excellent， the difference was not statistically significant（P>0.05）. Waking time of two groups were （6.8±2.1）min and （6.1±2.7）min， the difference was not statistically significant（P>0.05）. The incidence of respiratory depression， nausea， vomiting and dizziness in the observation group was significantly lower than that in the control group， the difference was statistically significant（P<0.05）. Conclusion In composite intravenous anesthesia nalbuphine combined with propofol in the bilateral eyelid shaping surgery has a good effect， intraoperative hemodynamic stability， smooth breathing， fewer adverse reactions and fewer complications， worthy of wide application in the bilateral eyelid plasty.endprint

Key words： nalbuphine hydrochloride injection； propofol； sufentanil； double eyelid surgery

随着舒适医疗、无痛技术的发展，重睑成形术求美者对其麻醉的要求也越来越高。之前采用氯胺酮、瑞芬太尼及舒芬太尼复合丙泊酚麻醉，镇痛、镇静效果确切，但因氯胺酮的交感神经、循环系统的兴奋作用，瑞芬太尼、舒芬太尼的呼吸抑制、恶心、呕吐发生率高，求美者的满意度较低[1]。纳布啡为阿片……