瑞芬太尼复合异丙酚在宫腔镜手术中的应用  

The application of remifentanil and propofol anesthesia for hysteroscopy

作　　者：周俊[1] 罗林丽[1] 林雪梅[1] 阮履强 

机构地区：[1]四川大学华西第二医院麻醉科,四川成都610041 [2]内江市中医院麻醉科,四川内江641001

出　　处：《四川医学》2009年第7期1021-1023,共3页Sichuan Medical Journal

摘　　要：目的观察瑞芬太尼复合异丙酚用于宫腔镜手术的临床效果和安全性。方法门诊宫腔镜术患者100例，ASAⅠ～Ⅱ级，随机分成两组：瑞芬太尼组（R组）：瑞芬太尼0．75μg／kg＋异丙酚2mg／kg；芬太尼组（F组）：芬太尼1μg/kg＋异丙酚2mg／kg。术中间断推注异丙酚维持麻醉，于术毕前2min停药，记录意识消失时间、术后苏醒时间、苏醒期不良反应及异丙酚用药量；呼吸和血流动力学变化；患者术中VAS评分和停药后改良OAA／S镇静评分。结果R组意识消失时间和苏醒时间较F组明显缩短，R组与F组相比异丙酚用药减少约30％（P〈0．05）；F组与R组比较平均动脉压（MAP）较基础值明显降低，R和F组呼吸暂停发生率分别为4％和24％（P〈0．05）；两组患者停药后3，4，5min改良OAA／S评分R组明显高于F组（P〈0．05）；但术中VAS评分和苏醒期不良反应两组间差异没有统计学意义（P〉0．05）。结论瑞芬太尼复合异丙酚在无痛宫腔镜术中应用。具有麻醉起效快、苏醒快和术中血流动力学稳定等优点，更适于门诊使用。Objective To investigate the clinical effects and safety of remifentanil and propofol during operation of hysteroscopy. Methods 100 ASA Ⅰ-Ⅱ patients undergoing outpatient hysteroscopy were randomly allocated into two groups. In the remifentanil group（ R group） anesthesia was induced with remifentanil 0.75μg/kg and propefol 2mg/kg, whereas in the fentanyl group （F group） was femanyl 1. 0μg/kg and propofol 2mg/kg, and was maintained with propofol when needed. The following were recorded and compared in the two groups ：（1）the time of unconsciousness, recovery time from anesthesia, the side effects during recovery and the total doses of propofol;（2）hemodynamic and respiratory changes during anesthesia;（3）pain visual analog scale（VAS） and observers＇ assessment of alertness/sedation（ OAA/S）. Results The time of unconsciousness and recovery time from anesthesia at group R was significantly shorter compared with group F; The total doses of propofol used were less at group R than F group （ P〈0. 05 ）. The MAP at group F was depressed significantly; The incidence of apnea at group R and F were 4 % and 24 % （P〈0. 0S）. There was significant difference in the OAA/S between the groups（P〈0. 05）. However, There was no significant difference between groups regarding VAS of pain and the side effects during recovery （ P〉0. 05）. Conclusion Remifentanil and propofol anesthesia appears to be superior for day-case hysteroscopy than fentanyl and propofol, with regards to the time consciousness and recovery time from anesthesia and stably hemodynamics.

关 键 词：麻醉 宫腔镜 二异丙酚 瑞芬太尼 芬太尼 

分 类 号：R614[医药卫生—麻醉学]