瑞芬太尼对无痛人流术中靶控输注丙泊酚用量的影响

Influence of a remifentanil bolus on the dosage of propofol during target-controlled infusion of propofol-anesthetized analgestic artificial abortion

目的:探讨在无痛人流术中0.3μg/kg瑞芬太尼对靶控输注(TCI)丙泊酚麻醉效能的影响。方法:42例拟行无痛人工流产术的年轻女性患者,随机分为丙泊酚组(P组,n=20)、丙泊酚复合瑞芬太尼组(RP组,n=22)。按序贯法要求,两组患者依次给予不同剂量丙泊酚,计算出50%患者对扩张宫颈或吸刮宫壁手术无逃避体动反应时所需的丙泊酚血浆浓度(Cp50)。于麻醉中连续监测患者心率(HR)、平均动脉压(MAP)和脉搏氧饱和度(SpO2),并监测患者麻醉镇静深度反应熵(RE)和人状态熵(SE)。以改良清醒镇静评分法(MOAA/S)评测麻醉过程中患者清醒程度。以Spearman秩相关分析患者麻醉清醒过程中MOAA/S评分同熵指数的相关性。结果:①RP组与P组扩张宫颈Cp50分别为3.495vs.4.637μg/kg,吸刮宫腔时Cp50分别为4.417vs.5.825μg/kg;②RP组丙泊酚用量和患者顺利完成手术时丙泊酚血浆浓度都显著少于P组(P<0.01);③RP组RE和SE在手术时间内皆显著高于P组(P<0.05或P<0.01),但在苏醒过程中差异并无显著意义;④两组患者麻醉清醒过程中MOAA/S评分同相应RE、SE皆为显著正相关(P<0.01)。结论:在青年女性患者无痛人工流产术中,0.3μg/kg瑞芬太尼可以显著减少TCI丙泊酚的半数有效血浆浓度,在浅麻醉镇静深度就可满足手术需要,但并不影响通过丙泊酚血浆浓度和熵指数对苏醒程度的预测和判断。

Objective：To evalate the effect of remifentanil （0.3 μg/kg） bolus on the efficacy of propofol during target-controlled infusion （TCI） of propofol anesthetized analgestic artificial. Methods：Forty-two young patients undergoing painless artificial abortion were randomly allocated to two groups：propofol group （group P, n = 20） and propofol plus re mifentanil group （group RP, n = 22）. Patients were sequentially given different doses propofol so that the 50% target propofol plasma concentration （CP50 which there is a 50% chance that patients show no movement in response for dilatation or curettage of cervix and uterine aspiration） could be determined by up-and-down sequential test. Anesthetic depth was observed by S/5TM Entropy. Heart rate （HR）,mean arterial pressure（MAP）, pulse oxygen saturation （SpO2） ,state entropy （SE） and response entropy （RE） were continuously monitored during anesthesia. Modified Observer＇s Assessment of Alertness/Sedation scale（MOAA/S） was used to detect the level of consciousness. Comparison of MOAA/S with RE and SE was performed with the Spearman correlation coefficient. Results：Propofol consumption and target propofol plasma concentration（Cp）were less than those in group P（P 〈 0.01 ）. CP50 of cervix dilatation was 3.495 vs. 4.637μg/kg in the group RP and group P. CP50 of cervix dilatation was 4.417 vs. 5.825 μg/kg in the group RP and group P. RE and SE of group RP were significantly higher than those of group P （P 〈 0.01 or P 〈 0.05） during operation but there were similar in the both groups during awaken time. MOAA/S was well positively correlated to RE and SE （P 〈 0.01） in both groups. Conclusion：In young female patients,0.3 μg/kg remifentanil bolus can effectively decrease CP50 values for TCI propofol and depth of anesthetic sedation, but it can not influence the ability of Cp and spectral entropy to predict and detect MOAA/S during painless artificial abortion.