丙泊酚自控镇静在甲状腺手术中的应用

Application of Propofol Patient-controlled Sedation in Thyroidectomy

目的探讨丙泊酚自控镇静在甲状腺切除术中的安全性及应用价值。方法ASAⅠ-Ⅱ级拟行甲状腺次全切除术的患者60例,随机分为丙泊酚自控镇静组（P组）和对照组（C组）,每组30例。P组手术开始时给予负荷量50 mg,然后开始患者自控镇静。给药模式为：每次给药量10 mg,每次给药时间0.33 min,锁定时间1 min,有效锁定时间1.33 min,5 min最大给药量30 mg,手术结束前5 min停药。C组手术开始时给予哌替啶1 mg.kg-1＋异丙嗪1 mg·kg^-1加入输液滴壶静脉滴注,术中不再追加其他镇静药物。监测两组术前、术中30 min及术后患者的收缩压（SBP）、心率（HR）及血氧饱和度（SpO2）,并记录镇静分数、合作分数及满意分数。结果P组术中30 min时SBP、HR、SpO2与C组同期相比差异有显著性（P〈0.05）,P组的镇静分数明显低于C组（P〈0.01）,而合作分数和满意分数明显高于C组（P〈0.05）。结论丙泊酚自控镇静可安全应用于甲状腺切除术,能很好地减轻患者焦虑,获得更高的满意度。

Objective To evaluate the safety and efficacy of propofol patient-controlled sedation （PCS） as a local anethesia in thyroidectomy . Methods Sixty patients （ASAⅠ-Ⅱ） undergoing thyroidectomy were randomly divided into group P（pcs,n=30） and group C（control, n=30）. In group P, after 50 mg of propofol as a loading dose, the patient-controlled sedation was induced by propofol using the Graseby9300PCA pump. Therapy procedurse were consisted of a lockout interval of one minute and a dose of propofol 10 mg, and 30 mg is the maximum dose in 5 minutes. Group C was only given pethidine 1 mg·g^-1 and promethazine 0.5 mg · kg^-1. Systolic blood pressure（SBP）, heart rate（HR）, serum oxygen saturation （SPO2 ） were recorded before infusion, 30 minutes after infusion and 5 minutes after operation. Sedation scores, cooperation degrees and satisfaction were also measured. Results The SBP, HR and SpO2 in group P were significiantly different from group C at the 30 minutes after infusion. Sedation scores were lower in group P （P〈0.01） , while cooperation and satisfaction scores were higher than that in group C （P〈 0.05）. Conclusions Propofol patient-controlled sedation is a safe and effective method with high satisfaction for thyroidectomy.