丙泊酚联合瑞芬太尼清醒镇静应用于宫腔镜检查术的临床研究  

Propofol Combined Remifentanil for Conscious Sedation in Hysteroscopy

作　　者：张立[1] 潘长青[1] 李华凤[1] 祝茜[1] 石钢[1] 

机构地区：[1]四川大学华西第二医院,四川成都610041

出　　处：《实用妇产科杂志》2009年第4期219-222,共4页Journal of Practical Obstetrics and Gynecology

基　　金：四川省科技厅应用基础研究项目(项目编号:04JY029-082-2)

摘　　要：目的:探讨并比较丙泊酚和瑞芬太尼不同给药方式及剂量在妇科门诊宫腔镜检查术清醒镇静及患者自控镇静中的临床应用。方法:130例患者随机分为对照组(L组,单纯局部麻醉)、丙泊酚组(0.6mg/kg,P组)、PR联合组1(丙泊酚0.3mg/kg加瑞芬太尼0.3μg/kg,PR1组)、PR联合组2(丙泊酚0.6mg/kg加瑞芬太尼0.6μg/kg,PR2组)、PR联合组3(丙泊酚0.3mg/kg加瑞芬太尼0.6μg/kg,PR3组)及PRPCS自控组(丙泊酚0.3mg/kg加瑞芬太尼0.6μg/kg)6组。监测术中生命体征和警觉/反应评分(OAA/S镇静评分),记录术中、术后不适及镇静满意度视觉模拟评分(VAS评分),术后留院观察时间和药物实际使用量等指标。结果:各镇静组(P、PR1、PR2、PR3、PRPCS)在面罩吸氧下仅1例发生轻度低氧血症;与对照组比较,各镇静组术中心率下降更明显(P<0.05);在各镇静组中,P组的OAA/S评分低于PR1、PR2、PR3和PRPCS组(P<0.05)。比较术中不适的VAS评分,L组最高,P组其次,PR1组居第3,其余3组(PR2、PR3、PRPCS)最低(P<0.05);而在满意度的比较中,PRPCS组评分最高,PR联合组(PR1、PR2、PR3)其次,P组居第3,且均高于L对照组(P<0.05)。镇静药物用量以P组最高,PR3组最低;而PR联合或自控组(PR1、PR2、PR3、PRPCS)术后滞留时间更少(P<0.05)。结论:在妇科门诊宫腔镜检查术清醒镇静的临床应用中,丙泊酚联合瑞芬太尼安全有效,且以丙泊酚0.3mg/kg加瑞芬太尼0.6μg/kg的比例给药为宜。在此基础上,自控镇静可进一步提高患者满意度。Objective：To explore and compare the clinical usage of Propctol combined with Remifentanil for conscious sedation in GYN outpatients＇ hysteroscopy. Methods： 130 patients were randomized into six groups according to dosage, Group L （ local anesthesia only for control）, Group P （ Propofol 0.6 mg/kg）, Group PR1 （ Propofol 0.3 mg/kg ＋ Remifentanil 0.3 μg/kg）, Group PR2 （ Propofol 0.6 mg/kg ＋ Remifentanil 0.6 μg/kg ）, Group PR3 （Propofol 0.3 mg/kg ＋ Remifentanil 0.6 μg/kg）,and Group PRPCS （Propofol 0.3 mg/kg ＋ Remifentanil 0.6 μg/kg for patient-controlled sedation）. Vital signs and OAA/S during the procedure of these patients were recorded, as well as VAS of unpleasant feelings and satisfactions, the total dosage, and monitoring time postoperation. Results：There was only one case of hypoxemia in 5 sedation groups while under mask oxygen inhalation. In 5 sedation groups, OAA/S of Group P was lower than others （ P 〈 0.05）. The VAS of unpleasant feelings by tums decreased Group L, Group P, Group PR1, and the other three groups （PR2, PR3, and PRPCS）. The VAS of satisfactions cut down from Group PRPCS, Group PR1, PR2, PR3, to Group P, that higher than Group L（ P 〈 0.05）. The dosage that needed for sedation was the highest in Group P while Group PR3 the least. The monitoring time in all PR combination groups （ PR1, PR2, PR3,and PRPCS） were significantly less than the others. Conclusions： Propofol combined Remifentanil is safe and effective in GYN outpatients＇ hysteroscopy, especially given in Propofol 0.3 mg/ kg ＋ Remifentanil 0.6 μg/kg. Patient-controlled sedation can increase patient satisfaction scores in basic combined sedation.

关 键 词：清醒镇静 患者自控镇静 丙泊酚 瑞芬太尼 宫腔镜检查 

分 类 号：R711[医药卫生—妇产科学]