靶控输注瑞芬太尼行MAC下无痛膀胱镜检查

Target controlled infusion of remifentanil in patients undergoing cystoscope

目的研究靶控输注瑞芬太尼用于无痛膀胱镜检查的可行性和安全性。方法将30位择期行膀胱镜检查患者,美国麻醉医师协会(American Society of Anesthesiologists,ASA)Ⅰ～Ⅱ级,分为2组(L和H组),2组均无术前用药。常规监护后进行效应室靶控输注瑞芬太尼,L组浓度为2μg/L,H组浓度为4μg/L,待到达靶浓度后开始手术操作。术中患者主诉疼痛或出现体动时以1μg/L为单位提高瑞芬太尼靶浓度,最高不超过6μg/L。若脉搏血氧饱和度低于90%则给予面罩加压给氧。在麻醉中观察并记录无创血压、心率、脉搏血氧饱和度、视觉模拟评分(visual analogue score,VAS)、脑电双频指数(bispectral index,BIS)、合并症发生率(呼吸抑制、血压下降、恶心、呕吐、咳嗽和躁动)以及瑞芬太尼用药总量、追加次数、最高靶浓度,并在2组间进行比较。结果 2组患者VAS评分均可达2～4分,L和H组平均BIS值分别为89±10和86±13(P>0.05)。2组患者靶控至预定浓度后血压有明显下降,进镜时收缩压、心率与入室时比较差异无统计学意义(P>0.05),L组与H组辅助呼吸发生率为2/15和8/15(P=0.02)。L和H组术中轻微体动的发生率分别为5/15和1/15(P=0.08)。瑞芬太尼总用药量分别为(125.5±77.7)μg和(242.5±72.6)μg。结论本实验中靶控输注瑞芬太尼,对于膀胱镜检能达到足够的麻醉深度,具有安全性和可行性。靶浓度为2～4μg/L时可提供适合的镇痛强度,同时能够减少不良反应。

Objective To estimate the feasibility and safety of monitored anethesia using target controlled infusion of remifentanil in patients undergoing cystoscopy.Methods Thirty patients（American Society of Anesthesiologists（ASA）Ⅰ～Ⅱ grade）,scheduled for cystoscope,were randomly allocated into two groups.All the patients were treated with target controlled infusion of remifentanil.The target concentrations were 3 μg/L in group L（n=15） and 4 μg/L in group H（n=15） respectively.Operations began as soon as the effective concentration reached preconcerted value.Bispectral index（BIS） was applied in both groups.When patients＇ actions appeared that disturbed the operation,higher level of remifentanil could be administered.Oxygen was given by mask routinely and to make breath manually when pulse oxygen saturation（SpO2）90%.Blood pressure,heart rate,SpO2 and BIS value were monitored.Other parameters such as visual analgesia score（VAS）,complications,dosage and frequency of remifentanil injection were also analyzed.Results BIS value of the two groups were 89±10 and 86±13 respectively,and the average VAS were 4.8 and 3.3 respectively,which showed good analgesic effects and were not significantly different.Manually assisted respiration was applied in 2/15 cases in group L and in 8/15 cases in group H（P=0.02）,respectively;the incidence of body action were 5/15 in group L and 1/15 in group H（P=0.08） respectively;total dosage of propofol given was（125.5±77.7）μg in group L and（242.5±72.6）μg in group H;all of the 5 parameters mentioned above were significantly different between the two groups.Conclusion The schemes of MAC in two groups are in enough depth of anesthesia in patients undergoing cystoscope.The concentration of 2～4 μg/L for remifentanil is considered as safe and effective,with less adverse effects.