靶控输注丙泊酚复合瑞芬太尼在消化道内镜粘膜下剥离术中的应用

Application of target-controlled infusion of propofol plus remifentanil infusion in endoscopic submucous dissection

目的观察靶控输注丙泊酚复合瑞芬太尼在消化道内镜粘膜下剥离术的应用效果。方法 ASAI~Ⅱ级、择期全麻下行消化道内镜粘膜下剥离术患者38例,随机分为丙泊酚组（A组）和丙泊酚＋瑞芬太尼组（B组）各19例。A组靶控输注丙泊酚（初始血浆药物浓度为3.0μg/ml）,视麻醉深度调整靶浓度0.1μg/ml。B组静脉注射瑞芬太尼负荷剂量1μg/kg,随后开始微量泵静脉输注瑞芬太尼0.1μg.kg-1.min-1,并同时靶控输注丙泊酚（初始血浆药物浓度为2.5μg/ml）,视麻醉深度调整靶浓度0.1μg/ml。观察麻醉前、麻醉后2 min、置胃镜后2 min及苏醒时患者的心率（HR）、平均动脉压（MAP）、脉搏氧饱和度（SpO2）、手术时间、丙泊酚的用量、苏醒时间以及不良反应发生率。结果与麻醉前相比,麻醉后2 min及置胃镜后2 min两组患者的MAP均下降（P〈0.01）;麻醉后2 min两组患者均发生一定程度的HR减慢和SpO2下降（P〈0.01）,但均为一过性,至置胃镜后2 min好转（P〉0.05）;并且两组患者中无1例发生心动过缓或呼吸抑制。两组患者之间各时间点的生命体征差异无统计学意义（P〉0.05）,术中两组患者各种不良反应的差异无统计学意义（P〉0.05）,两组患者手术时间无明显统计学差异（P〉0.05）。B组患者苏醒时间明显缩短并且丙泊酚用量明显减少（P〈0.01）。结论丙泊酚靶控输注复合瑞芬太尼在消化道内镜粘膜下剥离术中的麻醉效果安全可靠,且与单用丙泊酚相比,患者苏醒更快。

Objective To observe the anesthetic effect of target-controlled infusion（TCI） of propofol plus remifentanil infusion in outpatients undergoing endoscopic submucous dissection. Methods Thirty-eight patients with physical status I ～ Ⅱscheduled for an elective endoscopic submucous dissection under general anesthesia were enrolled in this study.All patients were randomly divided into two groups,group A（n=19）and group B（n=19）.In group A,the patients received a target-controlled infusion（TCI） of propofol with the initial plama concentration of 3.0μg/ml,and then the dose was titrated upward or downward by 0.1μg/ml according to the anesthesia depth.In group B,the patients received a bolus dose of remifentanil 1μg/kg intravenous injection,followed with an infusion rate of 0.1μgokg-1omin-1 by micro-pump plus target-controlled infusion（TCI） of propofol with the initial plasma concentration of 2.5μg/ml,and then the dose was titrated upward or downward by 0.1μg/ml according to the anesthesia depth.Heart rate（HR）,mean arterial blood pressure（MAP）,pulse oxygen saturation（SpO2）,the consumption of propofol,recovery time and the incidence rate of side effects were recorded.Results In both groups,MAP decreased 2 minutes after the induction of anesthesia and 2 minutes after the entry of gastroscpe compared to the preanesthesia period（P0.05）.In both groups,HR decreased and SpO2 fell to a certain extent 2 minutes after the induction of anesthesia（P0.01）,but the change was transient,and it attenuated 2 minutes after the entry of gastroscope（P0.05）.None of the patients in both groups developed severe bradycadia or respiratory suppression.At any time point,the difference of the vital signs between two groups was of no statistical significance（P0.05）.The difference of the overall intraoperative side effects between two groups was of no statistical significance（P0.05）,the operation time between two groups was of no statistical significance（P0.05）.The recovery time was much shorter and the consumption of propofol during the anesthesia was smaller for the patients in group B（P0.01）.Conclusions It is effective and safe to use target-controlled infusion（TCI） of propofol plus remifentanil infusion in outpatients undergoing endoscopic submucous dissection.Compared to single propofol infusion,patients receiving target-controlled infusion（TCI） of propofol plus remifentanil infusion recovered faster.