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论著:异丙酚血浆靶控输注不同浓度用于宫腔镜手术的比较
Investigation of the Optimal Plasma Target Controlled Infusion Concentration of Propofol for Patients Undergoing Hysteroscopy
张琳玲 温海燕 罗文杰
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作者单位:上海市松江区妇幼保健院麻醉科
中文关键字:异丙酚;靶控输注;宫腔镜;脑电双频指数
英文关键字:Propofol;Target controlled infusion;Hysteroscopy;Bispectral index
中文摘要:目的:分析宫腔镜手术静脉麻醉时不同异丙酚血浆靶控浓度的临床效应,以寻找宫腔镜手术中比较合适的异丙酚靶控血浆浓度。方法:选择静脉麻醉下行宫腔镜手术的患者90例,随机分成3组。静脉注射芬太尼1 μg/kg后,异丙酚血浆靶控浓度设为低剂量4.0 μg/mL组(LP组)、中等剂量4.5 μg/mL组(MP组)和高剂量5.0 μg/mL组(GP组)。持续监测脑电双频指数(bispectral index,BIS),分析3组患者的异丙酚用量、意识丧失时间以及呼吸循环的变化和术毕清醒时间。结果:与注药前相比,LP组扩宫颈时平均动脉压和心率显著升高(P<0.05),MP组无显著变化(P>0.05),GP组显著降低(P<0.05);LP组和MP组脉搏氧饱和度无显著变化(P>0.05),GP组显著下降(P<0.05);3组BIS值在扩宫颈时出现了不同程度的下降,其中GP组最低(P<0.05)。MP组和GP组意识丧失时间短于LP组(P<0.05),GP组意识丧失时间短于MP组 (P<0.05)。LP组和MP组清醒时间短于GP组(P<0.05)。LP组出现体动反应的例数显著多于其他2组(P<0.05);GP组呼吸抑制的例数显著多于其他2组(P<0.05)。3组患者的异丙酚用量以及手术时间均无显著差异(P>0.05)。结论:异丙酚血浆浓度4.5 μg/mL可能是宫腔镜手术静脉麻醉较适宜的输注浓度。
英文摘要:Objective: To investigate the optimal plasma target controlled infusion concentration of propofol for patients undergoing painless hysteroscopy. Methods:A total of 90 patients undergoing painless hysteroscopy were randomly divided into three groups (Group LP, Group MP and Group GP), in which propofol target controlled plasma concentration were set at 4.0, 4.5 and 5.0 ug/mL, respectively. With bispectral index (BIS) monitoring, the total dosage of propofol, the time patients spent falling into unconsciousness during induction, the changes of hemodynamics and the recovery time were recorded and analyzed. Results: Compared with before induction, mean arterial pressure and heart rate at the time of dilating cervix in Group LP increased significantly (P<0.05), while they decreased significantly in Group GP (P<0.05), but they had no significant change in Group MP(P>0.05). Pulse oxygen saturation in Group LP and Group MP showed no significant change (P>0.05) but it decreased significantly in Group GP (P<0.05). BIS value in all three groups decreased at the time of dilating cervix, particularly in Group GP (P<0.05). The time to fall into unconsciousness in Group MP and Group GP was shorter than that in Group LP (P<0.05), particularly in Group GP (P<0.05). Awake time in Group LP and Group MP was shorter than that in Group GP(P<0.05). There were significantly more cases who had body movement in Group LP than in the other two groups (P<0.05). Case number of respiratory depression in Group GP was significantly more than those in the other two groups (P<0.05). There were no significant differences in propofol dosage and operation duration among the three groups (P>0.05). Conclusion: 4.5 ug/mL may be the suitable concentration for plasma target controlled infusion of propofol in painless hysteroscopy.
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