瑞芬太尼复合丙泊酚在宫腔镜手术中的应用

Application of remifentanil combined with propofol in hysteroscopic surgery

目的:观察输注瑞芬太尼复合丙泊酚对宫腔镜下子宫内膜息肉电切术中患者呼吸及循环功能的影响。方法:选取择期行宫腔镜下子宫内膜息肉电切术患者60例,随机分为实验组,n=30和对照组,n=30。实验组静注瑞芬太尼0.5μg/kg与丙泊酚2mg/kg,然后以瑞芬太尼0.1μg.kg-1.min-1复合丙泊酚4mg.kg-1.h-1维持麻醉;对照组静注芬太尼2μg/kg与丙泊酚2mg/kg,然后以丙泊酚4mg.kg-1.h-1维持麻醉。观察术前基础(T1),注药后5min(T2),10min(T3),15min(T4)以及停药后5min(T5)的循环和呼吸情况,并记录意识消失时间、清醒时间和定向力恢复时间。结果:实验组各时间点MAP无明显变化,T2～T4时,HR减慢、MV减少、PETCO2升高,与基础值T1比较差异有统计学意义(P<0.05),但均保持自主呼吸;而对照组T2～T4时MAP下降、HR减慢、PETCO2升高,差异有统计学意义(P<0.05),实验组中体动患者明显少于对照组(P<0.05)。结论:在宫腔镜下行子宫内膜息肉电切术中,输注瑞芬太尼复合丙泊酚可使患者保持自主呼吸,对循环影响轻微,术后苏醒迅速、安全。

Objective： To observe the influence of remifentanil combined with propofol on patient circulation and respiration in hysteroscopic electrocision for endometrium polyp.Methods： 60 cases,which would be given hysteroscopic electrocision for endometrium polyp,were randomly assigned into experimental group（n=30） and control group（n=30）.The experimental group were given intravenous injection of remifentanil 0.5 μg/kg and propofol 2 mg/kg,then,0.1 μg·kg-1·min-1 remifentani and propofol 4 mg·kg-1·h-1 to maintain anaesthesia.The control group were given intravenous injection of fentanyl 2 μg/kg and propofol 2 mg/kg,then,propofol 4 mg·kg-1·h-1 to maintain anaesthesia.The circulation and respiration of patients were observed at preoperative foundation/T1,5 min/T2,10 min/T3,15 min/T4 after administration,as well as 5 min/T5 after cessation of medicine use.Losing and recovering consciousness time and directional force recovery time were recorded.Results： The mean arterial pressure（MAP） in experimental group at each time point showed no obvious change.While heart rate（HR）,minute ventilation（MV） decreased from T2 to T4,but the end-tidal partial pressure of carbon dioxide（PetCO2） increased,significantly different from T1（P0.05）.In the control group,the MAP and HR decreased during T2-T4,and PetCO2 significantly increased（P0.05）.There were less body movement patients in the experimental group than in the control group（P0.05）.Conclusions： During hysteroscopic electrocision for endometrium polyp,the application of remifentanil and propofol complex could make the patients breathe autonomously with less influence on circulation,and the patients can revive quickly and safely after operation.