异丙酚手控和靶控输注在经阴道取卵术中应用的对照研究

Comparative efficacy of anthesia between hand controlled infusion and target-controlled infusion infusion with propofol during Oocyte retrieval by vagina puncturing.

目的比较异丙酚手控输注(HI)和靶控输注(TCI)用于经阴道取卵术的麻醉效果,用药剂量及对患者呼吸和循环功能的影响。方法选择40例行阴道B超引导下穿刺取卵术的患者,美国麻醉学会(ASA)分级Ⅰ-Ⅱ级,随机分为HI组和TCI组。HI组设定初始剂量为2.5 mg/kg,30-45 s内推完,术中根据患者的体动反应追加药量0.5-1.0 mg/kg。TCI组设定初始血浆靶浓度为4μg/ml,扩宫口及穿刺时改为5.5-6.0μg/ml,取卵时改为3.5-4.5μg/ml。两组均在给药之前推注芬太尼1μg/kg,手术结束时停止给药。记录两组患者意识消失的时间、苏醒时间、用药量以及麻醉前后血压、心率、血氧饱和度的变化。结果TCI组意识消失的时间明显长于HI组(P<0.05),但苏醒时间明显短于HI组(P<0.05)。两组用药量无显著性差异(P>0.05)。HI组血压、心率、血氧饱和度下降者所占比例明显高于TCI组(P<0.05)。结论对于经阴道取卵术而言,TCI法较HI法具有更好的可控性和安全性。

Objective： To comparate the anesthetic efficacy, dosages and effects of propofol on respiratory and cardiovascular functions between target - controlled infusion （ TCI ） and hand - controlled infusion during oocyte retriebal by vagina puncturing. Methods： Forty ASA Ⅰ～Ⅱ patients undergone oocyte retrieval were randomly assigned to one of the following two groups, ie. TCI group （ n = 20 ） and HI （ n = 20 ）. In HI group , propofol was given at a blous injection of 2.0 mg/kg intravenously, and the dosage of 0.5 - 1.0 mg/kg was given according to the body movement response. In the TCI group, the initial blood target concentration of propofol was set at 4.0 μg/ml, then adjusted according to the operating progress. The target concentration was set at 5.5 - 6.0 μg/ml for dilating the cervices and puncturing, then the infused rate decreased to 3.5 - 4.5 μg/ml during occyte retrieval. Both groups were given fentanyl 1 μg/kg before propofol, and ceased to be given propofol by the end of the operation. The time of disappearance of consciousness, the recovery time and the total dosage of propofol wwere recorded simultaneously. The blood presuure, heart rate, and SPO2 were montiorted during the operation. Results ： The time of disappearance of consiousness in TCI group was longer than that in the HI group, but the recovery time was significantly shorter in TCI group （ P 〈 0.05 ）. There was no significandy difference of propofol requirement between the two groups （ P 〈 0. 05 ）. The rate of blood pressure fall, HR fall, SPO2 fall in HI group was greater than that in the TCI group. Conclusion： In compare with hand controlled infusion of propofol during occyte retrival the TCI provides better control and safety.