患者自控镇静用于眼底手术的临床研究

Comparison of patient-controlled sedation using either propofol or propofol-remifentail for ophthalmic operation

目的探讨球后阻滞眼底手术患者应用异丙酚和瑞芬太尼自控镇静(PCS)的优越性。方法42例择期球后阻滞眼底手术患者,随机分为3组:P组15例,应用1%异丙酚;R组15例,应用0.5%异丙酚+0.001%瑞芬太尼;C组12例,空白对照组。PCS组(P组、R组)采用爱朋全自动注药泵,选择负荷剂量+持续背景输注+PCS(LCP模式)静脉输注异丙酚和(或)瑞芬太尼。术中监测BP、HR、SpO2、RR、听觉诱发电位(AAI)、镇静评分(Ramsay评分)、患者合作评分、术者满意度,术后随访患者满意度和不良反应发生情况。结果三组术前情况差异无统计学意义。术后MAP、HR、SpO2和AAI差异无统计学意义(P>0.05)。R组RR显著低于P组、C组(P<0.05),PCS组的镇静评分、合作评分、满意度评分、球后阻滞疼痛评分明显优于C组(P<0.05),PCS组用药量个体差异较大。三组均无术后恶心、呕吐等现象。结论应用异丙酚、瑞芬太尼进行PCS可安全用于球后阻滞眼底手术,是一种适用于不同患者的较理想的方法。

Objective To explore the advantage of patient-controlled sedation （PCS） with propofol and/or remifentanil in ophthalmic operation under retrobulbar nerve block. Methods 42 patients with elective ophthalmic operation under retrobulbar nerve block were randomly divided into 3 groups;P group （1% propofol, n = 15 ）, R group （0.5%propofol ＋0.001% remifentanil,n = 15） and control group （n = 12）. Patients in PCS group had medications delivered in LCP fashion by automatic AIPENG pump. Ramsay, cooperation scores, BP, HR, SpO2 , RR and AAI were measured during the operation, and the satisfactory scores were measured after the operation. Results There was no significant difference in BP,FIR,SpO2 and AAI in all patients （P 〉0. 05） ,RR in R group was lower than that in P group and control group （ P 〈 0. 05 ）. Ramsay, cooperation and satisfactory scores in PCS group were higher than that in control group. There was greater individual variation in terms of propofol and remifentanil consumption in PCS group. No adverse event was observed. Conclusion Patient-controlled sedation with propofol and/or remifentanil can produce satisfied sedation in patients. Continuous monitor is significantly necessary during ophthalmic operation.