部位麻醉术中异丙酚自控镇静研究

Patient-controlled sedation with propofol in regional anesthesia

目的研究部位麻醉术中异丙酚自控镇静（ＰＣＳ）的临床应用方法及具麻醉效果。方法选择ＡＳＡ分级Ⅰ－Ⅱ级手 术病人３０例，使用Ｇｒａｓｅｂｙ 镇痛泵静脉给药，每次给药量为８ ｍｇ，２０ ｓ完成，无锁定时间，病人可根据需要按压给药按 扭，直至满意。每 ５ ｍｉｎ记录一次镇静程度、呼吸通畅程度、脉搏血氧饱和度、血压、心率、按压次数和实际给药次数。结 果异丙酚ＰＣＳ起效时间为（２．９±１．４）ｍｉｎ。在３６０次记录中无一镇静过度。所有病人脉搏血氧饱和度及呼吸道通畅度 均未受影响。在 ＰＣＳ最初 ５ ｍｉｎ内按压次数和实际给药次数均较多（Ｐ＜０．０５），随后明显减少并趋稳定。血压、心率均较 稳定。９５％病人对此方法评价好，愿接受。结论异丙酚ＰＣＳ具有安全、可靠，对呼吸、循环影响小，病人易于接受等优 点，可应用于部位麻醉病人术中镇静。

Objective To investigate the anesthetic effects of patient-controlled sedation (PCS) using propofol and explore the means of sedative administration Methods Thirty patients for selective surgery with regional anesthesia (ASA I -Ⅱ ) were enrolled in this study. Propofol administration was controlled by the patients by patients the button themselves, and each push would release 8 mg propofol in a coarse of 20 s. The patients were allowed to press the button as much as they wished without lockout till satisfactory anesthetic effect was achieved. Sedation level, blood pressure (BP), heart rate (HR), times of pressing the button and the actual doses administered were recorded every 5 min. Results The sedative took effect at (2.9± l.4) min and no oversedation occurred. SpO2 and airway condition were normal in all patients, and BP and HR were stable. More frequent demands for and larger doses of the sedative were noted during the first 5 min (P<0.01), which decreased significantly in the following 10 to 15 min, remaining at low levels afterwards. Patient satisfaction late was 95%. Conclusion PCS with propofol is a safe, reliable and acceptable method for local anesthesia.