丙泊酚靶控输注联合芬太尼静脉镇静拔除下颌阻生智齿的效果评价

Evaluation of propofol target controlled infusion with fentanyl intravenous sedation on the removal of impacted wisdom tooth

目的：评价丙泊酚靶控输注（target controlled infusion,TCI）联合小剂量芬太尼用于下颌阻生智齿拔除术的效果及安全性.方法：选择拔除下颌阻生智齿的患者58例（18--45岁）,均为美国麻醉医师协会（American Society of Anesthesiology,ASA）分级Ⅰ--Ⅱ级,按用药的不同分为两组：对照组（n=26）,40 mg利多卡因＋丙泊酚TCI;实验组（n=32）,0.8 μg/kg芬太尼＋丙泊酚TCI,记录各项评价指标并进行分析比较.结果：两组患者性别分布、年龄、体重、手术时间及镇静时间差异无统计学意义.除局部麻醉注射时实验组的心率及脑电双频普指数明显低于对照组（P〈0.05）外,术中同一时间点两组间的心率、平均动脉压、呼吸频率、脉搏氧饱和度、脑电双频普指数差异均无统计学意义,且两组患者对局部麻醉注射、手术开始及牙钻的记忆差异亦无统计学意义.实验组的丙泊酚注射痛、局部麻醉注射体动、术中多语发生率均明显低于对照组,差异有统计学意义（P〈0.05）.回访两组患者均无恶心及呕吐发生,实验组19例（19/32）、对照组14例（14/26）患者回家后再困倦.患者的满意度评分在两组间差异无统计学意义,但医师的满意度评分实验组明显高于对照组（P〈0.05）;同组患者的满意度评分均明显高于医师（P〈0.05）.结论：丙泊酚TCI联合小剂量芬太尼静脉镇静下拔除下颌阻生智齿舒适安全,患者及医生满意度较高.

Objective：To evaluate the effect and safety of propofol target controlled infusion （TCI） with a small dosage of fentanyl intravenous sedation on the removal of the third impacted molar tooth. Methods： In the study, 58 ASA （American Society of Anesthesiology） Ⅰ--Ⅱpatients with impacted wisdom tooth re- moval （age： 18 -45 years）, were divided into two groups： control group （n =26） received 40 mg lido- caine ＋ propofol TCI; experimental group （ n = 32） received 0.8 ~g/kg fentanyl ＋ propofol TCI. The com- plete evaluating indexes were recorded, and the data compared and analyzed. Results： The differences of the gender, age, weight, operation time and sedation time were not significant. The heart rate and bispec- tral index of the experimental group on local anesthesia injection were significantly lower than those of the control group （P 〈 0.05）. Other differences on heart rate, mean blood pressure, pulse oxygen saturation, respiration rate and bispectral index between the two groups were not significant during operation. The differences on recall of local anesthesia injection, incision and drilling between the two groups were not sig- nificant. The pain caused by the propofol injection, and the body movement caused by local anesthesia in- jection and talkativeness during operation in the experimental group were significantly lower than those in the control group （P 〈0.05）. No patient in the two groups had nausea and vomiting. After discharge, 19 patients in the experimental group （19/32）, 14 patients in the control group （14/26） were sleepy after coming home. The difference of the patient＇ s satisfaction between the two group was not significant, but the patient＇s satisfaction was significantly higher than the doctor＇s （P 〈 0, 05）, and the doctor＇s satisfac- tion in the experimental group was significantly higher than that in the control group （P 〈 0.05）. Conclu- sion： Propofol TCI with a small tooth is effective and safe. Both dosage of fentanyl intravenous sedation patients and doctors have high degree on the removal of impacted wisdom of satisfaction on it.