不同滴定终点在无痛取卵术滴定麻醉中的比较  

Comparison of Different End Points Used in Titrated Anesthesia for Painless Oocyte Retrieval

作　　者：冯红斌[1] 白虹[1] 文依[1] 李冬雪[1] 李子嘉[1] 陈丽红[1] 靳三庆[1] 

机构地区：[1]中山大学附属第六医院麻醉科,广东广州510655

出　　处：《中山大学学报（医学科学版）》2014年第1期87-93,共7页Journal of Sun Yat-Sen University:Medical Sciences

基　　金：广东省科技计划项目(2010B080701073)

摘　　要：[目的]比较经阴道超声引导下穿刺取卵术（TUGOR）麻醉中不同滴定终点的麻醉效果及其对呼吸循环的影响,以探索无痛取卵术麻醉时的最佳滴定麻醉方案.[方法]150例拟行无痛取卵术患者,随机分为3组,MOAA/S评分组（M组）、Ramsay镇静评分组（R组）及脑电双频谱指数组（B组）,每组50例.3组病人于静脉注射芬太尼10 μg1 min后开始诱导,采用丙泊酚滴定给药方式,以1 mg· kg-1· min-1速度持续静脉泵注,分别以MOAA/S评分达1分、Ramsay镇静评分达6分以及BIS值达40 ～ 50为诱导终点.麻醉维持阶段3组均在丙泊酚4 mg· kg1·h-1持续静脉泵注的基础上进行调整.记录患者各时间点时平均动脉压（MBP）、收缩压（SBP）、舒张压（DBP）、心率（HR）、脉搏氧饱和度（SPO2）.记录术中不良反应例数并记录操作者和患者术后对麻醉的满意度情况.记录丙泊酚诱导用药量、维持用药量及麻醉诱导时间、维持时间、苏醒时间、离室时间.[结果]MAP的变化在诱导完毕时、进针后3 min R组较B组平稳（P＜0.05）,SBP的变化诱导完毕时R组较B组平稳（P＜0.05）.3组间并发症发生率（低氧血症、低血压等）无统计学差异（P＞0.05）.R组、B组操作者及患者术后满意度均高于M组（P＜0.05）,而R组和B组间操作者及患者术后满意度无统计学差异（P＞0.05）.3组患者丙泊酚诱导用药量、单位时间维持用药量、用药总量及麻醉诱导时间、苏醒时间、离室时间均无统计学差异（P＞ 0.05）.[结论]3种滴定麻醉的给药方案在无痛取卵术中均可获得较满意的麻醉.相对地,以Ramsay镇静评分达6分作为滴定诱导终点应用于无痛取卵术滴定麻醉时对患者呼吸循环影响小,获得患者及操作者更高满意度.[ Objective ] To find an appropriate titrated anesthesia protocol for painless transvaginal ultrasound-guided oocyte retrieval though comparing the anesthesia effects and side effects on circulation and respiration among the regimens used different titrated end points. [ Method ] One hundred and fifty patients scheduled for elective painless oocyte retrieval with ASA physical status I - II, were randomly allocated to three groups （50 patients each）. All patients received fentanyl 10 ug intravenously 1 minute before induction, then propofol was intravenously administered at the rate of 1 mg. kg-1. min-1 until induction finished. In group M MOAA/S scale reached 1 was used as induction end point, while in group R Ramsay sedation scale reached 6, and in gourp B the bispectral index reached 40-50. During the maintenance period all patients received intravenous propofol continuously adjusted at the basic rate of 4 mg.kg-1 .min-1. MBP, DBP, SBP, SpO2, HR were recorded at different time points. The complications and the satisfaction degree from patients and operator also recorded. The propofol induction dose, maintenance dose, total dose and induction time, awakening time, time from awakening to leaving were recorded respectively. [ Result ] In group R AMAP and ASBP were significantly less than group B （P 〈 0.05） after induction immediately, three minute after puncture, group R had less AMAP than group B （P 〈 0.05）. The satisfaction degrees both from patients and operator were higher in group B and group R than group M, there was no significant different between group R and group B. No significant differences were found among the groups in the induction, maintenance, and total dosage of propofol. There were no significant differences in the ADBP, HR, SpO2, and induction time,recovery time, time from awakening to leaving and the rate of complications among groups （P 〉 0.05）. [Conclusion] The protocol of titrated anesthesia can be applied in transvaginal ultrasound-guided oocyte retrieval safely and

关 键 词：丙泊酚 诱导 滴定给药 无痛取卵 

分 类 号：R614[医药卫生—麻醉学]