靶控输注异丙酚镇静在第三磨牙拔除手术中的应用

The application of sedation by propofol itrated under target-controlled infusion in third molar extraction surgery

目的评价滴定法靶控输注异丙酚镇静在第三磨牙拔除手术中应用的安全性。方法选择择期接受第三磨牙拔除手术的患者60例,年龄19岁~54岁,ASA分级I^II级。随机分为两组:P组(异丙酚组,n=30)和C组(对照组,n=30)。P组:滴定法靶控输注异丙酚,初始血浆浓度0.8μg/ml,每2分钟增加浓度0.2μg/ml。至OAA/S评分3分时,2%利多卡因与1:200000肾上腺素混合液局麻后进行手术。C组:2%利多卡因与1:200000肾上腺素混合液局麻后进行手术。分别观察P组和C组患者术中配合情况,并记录P组患者入室平静后T_0、输注异丙酚起效时(T_1)、局麻时(T_2)、手术开始(T_3)、术中(T_4)、手术结束时(T_5)以及出室时(T_6)的心率、血压、血氧饱和度和呼吸频率和NI指数和对照组在上述对应时间点的心率、血压、血氧饱和度和呼吸频率。并记录相关反应情况。结果两组患者均能配合完成手术。T1~5时心率、收缩压及舒张压P组明显低于C组(P<0.05);血氧饱和度及呼吸频率两组无明显差异,均在正常范围内。NI指数在T_1~5时与T0比较差异有统计学意义(P<0.05)。结论采用滴定法靶控输注异丙酚镇静用于第三磨牙拔除手术是安全有效的。

Objective To evaluate the safety of sedation titrated under target-controlled infusion of propofol in third molar extraction surgery. Methods Sixty aged between 19~54 years old, were selected in the third molar extraction surgery. All patients qualified to ASA physical status of I or II were divided randomly into two groups ： group P（propofol group, n=30）and group C（controll group, n=30）. Group P： A titrated infusion of propofol with a preset target plasma concentration of 0.8μg/ml was started.The target concentration was increased in steps of 0.2μg/ml every 2 minutes until the OAA/S score had reached level 3.Then the surgery began after local anaesthetic was given（2% lidocaine with 1 in200000 epinephrine）. group C： The surgery began after local anaesthetic was given（2% lidocaine with 1 in 200000epinephrine）. The patient＇s cooperation in surgery was observed in group P and group C respectively. In all patients, the heart rate, blood pressure, respiratory rate, oxyhemoglobin saturation were recorded during the operation, and above indices in two the groups were compared in the following time points： T_0： after entering the operative room, the patients being quiet; T_1： the OAA/S score reached 3 under infusion of propofol; T_2： local anesthesia; T_3： surgery began; T_4： in the process of surgery; T_5： surgery completed; T_6： left the operative room. Narcotrend Index in group P was recorded in above time points as well. Results All the surgeries in two groups were completed favourably. The heart rate, blood pressure in group P was lower at T_1~5than that in group C（P〈0.05）. The oxyhemoglobin saturation and respiratory rate intwo groups were no significant difference. Narcotrend Index was lower at T_1~5than at T_0 in group P（P〈0.05）. Conclusion The sedation titrated under target-controlled infusion of propofol in third molar extraction surgery is effective and safety.