不同剂量芬太尼复合丙泊酚麻醉用于经阴道穿刺取卵术

A study of the effect of two doses of fentanil combined with propofol for intravenous anaesthesia during transvaginal oocyte retrieval

目的观察比较不同剂量芬太尼复合丙泊酚麻醉用于经阴道穿刺取卵术的效果。方法204例经阴道穿刺取卵术的患者,分为2组(n=102):芬太尼50μg复合丙泊酚组(A组)和芬太尼100μg复合丙泊酚组(B组)实施静脉麻醉。记录2组患者手术情况、手术过程中不良反应和不同体重及麻醉时间对药效学的影响。结果2组病人麻醉时间,手术时间,丙泊酚总用量,手术结束至病人离开时间,术后患者满意度,麻黄碱和阿托品的使用差异无统计学意义(P>0.05)。B组脉搏血氧饱和度(pulse oxygen saturation,SpO2)<95%和辅助呼吸的发生率较A组高,体动的发生率较A组低,差异有统计学意义(P<0.01,P<0.05)。体重40～54kg的患者B组收缩压(systolic blood pressure,SBP)<90mmHg、SpO2<95%、辅助呼吸的发生率较A组高,而体动的发生率较A组低,差异有统计学意义(P<0.01,P<0.05)。麻醉时间在16～20min的患者丙泊酚总用量A组多于B组(P<0.01)。结论在经阴道超声取卵术麻醉中,芬太尼100μg复合丙泊酚麻醉与芬太尼50μg相比,抑制体动的效果好,但发生呼吸抑制的例数较多。临床使用中,可根据患者的体重和卵泡数量的多少决定芬太尼的用量。推荐在体重小于55kg或卵泡数目少,预计麻醉时间少于15min的情况下使用芬太尼50μg;体重55kg以上或卵泡数目多,预计麻醉时间长于15min的情况下,使用芬太尼100μg。

Objective To compare the effect of two doses of fentanil combined with propofol for intravenous anaesthesia during transvaginal oocyte retrieval. Methods 204 infertile women undergoing transvaginal oocyte retrieval for in vitro fertilization procedures were randomly allocated to receive either fentanil 50μg （Group A） or fentanil 100 μg （Group B）. Then both groups were given propofol for intravenous anaesthesia during transvaginal oocyte retrieval. NBP, HR, SpO2 and ECG were continuously monitored and all patients were Spontaneously breathing with oxygen 5L/min. Ephedrine 10mg was given when SBP 〈 80 mmHg and atropine 0. 5mg was injected when HR 〈50 bpm. If SpO2 〈90 %, ventilation was manually assisted using facemask. The total dose of propofol, patient motion, anesthesia time, operation time, the time since the end of operation to the patient recovery （ The recovery is the time when the patient can open eyes at verbal command and stand up and then were transferred to the ward） , patient acceptance, need for manual ventilation and the use of ephedrine and atropine were recorded and compared between group A and group B. Methods There was no difference in the total dose of propofol, patient motion, anesthesia time, operation time, the time since the end of operation to the patient recovery, the amounts of SBP 〈 90mmHg, patient acceptance, the use of ephedrine and atropine between Groups A and B. The incidence of SpO2 〈 95 % and manual ventilation was significantly higher, but the incidence of Patient motion was lower in Group B than in Group A （P 〈 0. 01, P 〈 0. 05）. In the patients which weight were between 40 - 54 kg, the incidence of SBP 〈 90 mmHg, SpO2 〈 95 % and manual ventilation was significantly higher, but patient motion happened lower in Group B than in Group A （ P 〈 0. 01, P 〈0. 05 ）. No differences was observed in patient which weight was between 55 - 64 kg and up to 65kg, and in the patients which anesthesia time were bellowed 15 minutes between two groups. In the patients which anesthesia time was between 16 ~ 20 minutes, the total dose of propofol was significantly higher in Group A （P 〈 0. O1 ）. Conclusion Anesthesia with fentanil 100 μg combined with propofol has better effects on inhibition of patient motion, but has more strengthen depressant effect on respiratory function than fentanil 50μg combined with propofol during transvaginal oocyte retrieval. Fentanil 50 μg should be given if patient＇ s weight is below 55 kg or anesthesia time is shorter than 15 minutes. Fentanil 100μg may be selected if patient＇ s weight over 55 kg or anesthesia time is longer than 15 minutes.