瑞芬太尼与丙泊酚不同配伍复合麻醉用于经阴道超声引导下穿刺取卵术的临床效果

Anesthetic efficacy of a combination of different doses of remifentanil and propofol for ultrasound-guided transvaginal oocyte retrieval

目的评价瑞芬太尼与丙泊酚不同配伍复合麻醉应用于经阴道超声引导下穿刺取卵术麻醉的临床效果。方法选择美国麻醉医师协会(ASA)分级Ⅰ或Ⅱ级、择期行经阴道超声引导下穿刺取卵术的患者120例,随机分入瑞芬太尼1.5μg/kg+丙泊酚1.0 mg/kg组(瑞芬太尼1.5+丙泊酚1.0组)、瑞芬太尼1.5μg/kg+丙泊酚1.5 mg/kg组(瑞芬太尼1.5+丙泊酚1.5组)、瑞芬太尼1.0μg/kg+丙泊酚1.5 mg/kg组(瑞芬太尼1.0+丙泊酚1.5组)和瑞芬太尼1.0μg/kg+丙泊酚1.0 mg/kg组(瑞芬太尼1.0+丙泊酚1.0组),每组30例。术中根据患者的体动反应和自诉疼痛情况,酌情追加瑞芬太尼和(或)丙泊酚。根据患者的定向力恢复时间、低氧血症和不良反应(咳嗽、舌后坠)发生率、麻醉起效时间评价其麻醉质量,记录心率(HR)基础值和术中最低值。于麻醉诱导前、睫毛反射消失和定向力恢复后记录瑞芬太尼1.5+丙泊酚1.5组患者的平均动脉压(MAP)。患者进入麻醉后监测治疗室,常规行警觉/镇静评分(OAA/S评分)。结果瑞芬太尼1.5+丙泊酚1.5组和瑞芬太尼1.0+丙泊酚1.5组的麻醉起效时间均显著短于瑞芬太尼1.5+丙泊酚1.0组和瑞芬太尼1.0+丙泊酚1.0组(P值均<0.05),定向力恢复时间均显著长于瑞芬太尼1.5+丙泊酚1.0组和瑞芬太尼1.0+丙泊酚1.0组(P值均<0.05)。各组间低氧血症发生率和不良反应发生率的差异均无统计学意义(P值均>0.05)。瑞芬太尼1.5+丙泊酚1.5组和瑞芬太尼1.0+丙泊酚1.5组的术中初次丙泊酚用量均显著多于瑞芬太尼1.5+丙泊酚1.0组和瑞芬太尼1.0+丙泊酚1.0组(P值均<0.05),瑞芬太尼1.0+丙泊酚1.5组和瑞芬太尼1.0+丙泊酚1.0组的术中初次瑞芬太尼用量均显著少于瑞芬太尼1.5+丙泊酚1.0组和瑞芬太尼1.5+丙泊酚1.5组(P值均<0.05),但各组间术中追加丙泊酚和瑞芬太尼剂量的差异均无统计学意义(P值均>0.05)。4组HR术中最低值较基础值均有减慢趋势,但差异均无统计学意义(P值均>0.05);各组均无患者发生心动过缓。瑞芬太尼1.5+丙泊酚1.5组睫毛反射消失和定向力恢复后的MAP均显著低于麻醉诱导前(P值均<0.05)。各组中术后OAA/S评分≤3分的患者构成的差异均无统计学意义(P值均>0.05)。结论芬太尼与丙泊酚的各种配伍复合麻醉均具有麻醉起效和苏醒迅速的特点;瑞芬太尼与丙泊酚合用,麻醉起效和麻醉后患者定向力恢复时间取决于丙泊酚用量;无论何种配伍,均须严密关注不良反应(咳嗽、舌后坠)和低氧血症的发生。

Objective To evaluate the anesthetic efficacy of a combination of remifentanil and propofol of different doses for ultrasound-guided transvaginal oocyte retrieval. Methods A total of 120 female patients {American Society of Anesthesiologists physical status I or ]]＂ ） scheduled for transvaginal oocyte retrieval were enrolled in this study. They were randomly assigned to four groups （n = 30）= group A {infusion with remifentanil 1.5 μg/kg ＋ propofol 1.0 mg/kg）, group B （infusion with remifentanil 1.5 pg/kg ＋ propofol 1.5 mg/kg）, group C （infusion with remifentanil 1.0 μg/kg ＋ propofol 1.5 mg/kg） and group D （infusion with remifentanil 1.0 pg/kg ＋ propofol 1.0 mg/kg）. Additional remifentanil and （or） propofol were given according to body movement andpain. The anesthesia was evaluated based on the following main indicators： recovery time of orientation, the incidences of hypoxemia and adverse reactions （cough and glossocoma）, and onset time. Heart rate （HR） before induction of anesthesia （baseline） and minimum during the surgery were recorded. Mean arterial pressure （MAP） in group B was observed at the following time points： before induction of anesthesia, onset time, and recovery time of orientation. Observer assessment of alertness score （OAA/S） was evaluated after anesthesia. Results Onset time in groups B and C were significantly shorter than those in groups A and D （all P〈O. 05）. However, the recovery time of orientation in groups B and C were much longer than those in groups A and D （all P〈O. 05）. There were no significant differences in the incidence of hypoxemia or adverse reactions between groups （all P〉 0.05）. Primary dosage of propofol in groups B and C were significantly more than those in groups A and D （all P〈O. 05）. Primary dosage of remifentanil in groups C and D were significantly less than those in groups A and B （all P〈O. 05）. No significant difference were found in additional use of propofol or remifentanil between groups （all P〉0.05）. HR decreased significantly during anesthesia compared with respective baselines in four groups （all P〈O. 05）; however there was no patient with bradycardia （HR〈50/min）. MAP at the onset time and recovery time of orientation were significantly lower than that before induction of anesthesia in group B （both P〈 0.05）. OAA/S had no significant difference among groups （all P〉O. 05）. Conclusion A combination of propofol and remifentanil can achieve rapid onset and recovery for anesthesia in transvaginal oocyte retrieval. Onset time and recovery time of patients＇ orientation depend on the dosage of propofol during this combined use. However, the respiratory function is inevitably affected in all combinations, and adverse reactions （cough and glossocoma） and hypoxemia should be intensively monitored. （Shanghai Med J, 2016, 39： 588-592）