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依托咪酯、咪唑安定复合芬太尼麻醉应用于肛肠科PPH手术临床研究（稿号2010042300152修回稿）
Studying the Etomodate/mid add Fentanyl intravenous anesthesia in the PPH

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DOI:
作者:
顾明红，朱婵 ，李浪平 ，李传明 ，邵逸
Gu Minghong, Zhu Chan, Li Langping, Li Chuanming
作者单位:
上海市嘉定区中医医院麻醉科
Department of Anesthesiology, Jiading Hospital of Traditional Chinese Medicine, Shanghai
关键词:
静脉麻醉，依托咪酯，PPH手术
intravenous anaesthesia etomidate procedure for prolapse and hemorrhoids
摘要:
目的 研究依托咪酯、咪唑安定复合芬太尼静脉麻醉比较硬腰联合麻醉下行PPH手术的麻醉特点、注意事项。 方法 对2009年6-12月以来本院肛肠科行PPH手术病员60例分为A、B二组，A组为实验组B组为对照组，观察BP、ECG、SPO2, 麻醉起效时间、肌松情况以及自主活动恢复时间。A组全程观察脑电双频谱指数(Bispectral Index，BIS)数值、术后随访并发症情况、患者满意度情况，进行对比分析。结果 二组麻醉均可完成手术，二组病人年龄、体重、麻醉肌松无明显差异。A组起效明显快于B组；A组自主活动恢复明显快于B组；A组术后头痛、腰痛、尿潴留发生率明显小于B组；二组病员术后均有恶心、呕吐发生，但无显著差异。结论 依托咪酯、咪唑安定复合芬太尼用于PPH手术麻醉诱导，麻醉效果与硬腰联合麻醉效果相仿，均能满足手术要求，并发症少，恢复快、病员舒适满意度高，有明显优势。PPH手术后部分病员易发生恶心、呕吐情况，可用一定药物进行预防,如地塞米松5mg 和 昂丹司琼 2mg。
Objective Studying the features and attentions of Etomodate/mid add Fentanyl intravenous anesthesia in the PPH comparing with CSEA(combined spinal epidural anaesthesia). Methods: 60 patients who had been done the PPH since June to December, 2009 in our hospital were randomly divided into 2 groups. A was the test group and B was the experimental control group. BP, ECG, SPO2, onset time of effect, muscle relaxation, complications, events autonomous recovery time and patients’ satisfaction were recorded. Bispectral index(Bis) of group A was also recorded. Results Both groups underwent the operation. Age, weight, muscle relaxation all did not display significant difference between the two groups. Group A is shorter than group B in the onset time of effect and the time of events autonomous recovery. The percents of complications such as headache, uroschesis, and back pain in group A is by far, less than that of group B. Nausea and vomiting exist in both groups no significant difference could be detected. Conclusion: Etomodate/mid add Fentanyl used during the anesthetization for the operation of PPH can achieve the same result as CSEA, and has the advantages of faster onset, more quickly regained consciousness, less significant complications, and patients are more prone to accept the treatment. Nausea and vomiting after this operation can be prevented on some patients by some drugs such as Dexamathasone 5mg and Ondansetron 2mg..

 

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