丙泊酚、瑞芬太尼联合小剂量咪达唑仑静脉麻醉在妇科门诊手术中的应用

Application of propofol and remifentanil combined with low dose of midazolam intravenous anesthesia in gynecological outpatient surgery

目的 观察丙泊酚、瑞芬太尼联合小剂量咪达唑仑静脉麻醉在妇科门诊手术中的疗效和安全性.方法 选择行妇科门诊手术的患者120例,按照随机数字表法分为对照组和观察组,各60例.对照组患者静脉缓慢注射瑞芬太尼1μg/kg、丙泊酚1～2 mg/kg;观察组开始静脉依次缓慢注射咪达唑仑0.02 mg/kg、瑞芬太尼1 μg/kg、丙泊酚1～2 mg/kg,待患者睫毛反射消失后开始手术操作.术中麻醉可追加丙泊酚20～40 mg.观察两组患者观察两组患者麻醉起效时间,达到镇静（Ramsay）评分4分的时间,苏醒时间,观察两组患者镇静满意度,谵妄发生率及平均谵妄评分,记录不良反应发生情况.结果 手术后及完全苏醒时,两组患者平均动脉压（MAP）、心率（HR）、血氧饱和度（SpO2）、呼气间期（RR）开始下降,至完全苏醒时有所升高,两组患者各项生命体征在术后与治疗前相比差异均有统计学意义（对照组手术后：MAP：t=15.09,P=0.00;HR：t=16.54,P=0.00;SpO2：t=4.01,P=0.00;RR：t=3.40,P=0.00;观察组手术后：MAP：t=10.86,P=0.00;HR：t=12.82,P=0.00;SpO2：t=2.45,P=0.01;RR：t=2.77,P=0.00）,在完全苏醒时,对照组生命体征与治疗前相比差异均有统计学意义（对照组：MAP：t=11.18,P=0.00;HR：t=5.73,P=0.00;SpO2：t=1.73,P=0.04;

Objective To observe the efficacy and safety of propofol and remifentanil combined with low dose of midazolam intravenous anesthesia in gynecological outpatient surgery.Methods 120 patients with gynecological outpatient surgery were randomly divided into control group and observation group.The control group received intravenous injection of remifentanil 1μg/kg,propofol 1.2mg/kg,the observation group received intravenous injection of midazolam 0.02mg/kg,remifentanil 1μg/kg,propofol 1.2mg/kg,until the disappearance of eyelashes began operation.Intraoperative anesthesia could be added propofol 20-40mg.The anesthesia onset time,to the sedation （Ramsay） score of 4,points wake up time of the two groups were observed,the sedative satisfaction,delirium incidence and the average delirium score,the incidence of adverse reactions were recorded.Results After operation and when fully awake,the mean arterial pressure （MAP）,heart rate （HR）,oxygen saturation （SpO2） and expiratory interval （RR） of the two groups were decreased,and rised somewhat at fully awake,there were significant differences in the vital signs between the two groups before and after treatment （the control group after operation：MAP：t=15.09,P=0.00;HR：t=16.54,P=0.00;SpO2：t=4.01,