异丙酚TCI镇静靶控技术在宫腔镜手术中的应用

Clinical Effects of Propofol Target-Controlled Infusion (TCI) in Hysteroscopic Surgery

目的探讨异丙酚靶控输注(target controlled infusion,TCI)麻醉在宫腔镜手术中的应用效果。方法择期进行宫腔镜手术患者100例,年龄26~42岁,体重46~60 kg,ASA分级Ⅰ~Ⅱ级,随机分成TCI组和对照组各50例;外科医生消毒时静脉滴入芬太尼2μg/kg。对照组按常规经验首次注射1%异丙酚2~3 mg/kg后,依患者表情及体动情况分次静注异丙酚20~30 mg以加深麻醉;TCI组利用Graseby3500TCI微量泵进行异丙酚血浆MASH模式TCI,初始目标血浆浓度(Cp)设定为2μg/ml,当警觉-镇静评分(OAAS)达到2分或以下时为入睡浓度,维持入睡浓度,依患者表情及体动情况适当调节,记录术前、手术扩宫、进镜、宫内操作及清醒时的HR、SBP、DBP、SPO2,及TCI组各时间点效应室浓度(Ce),统计两组的异丙酚用量,进行统计学分析。结果对照组异丙酚总用量为(391.3±74.5)mg,平均用量为(0.21±0.08)mg/kg,明显高于TCI组(209.7±83.0)mg和(0.11±0.02)mg/kg(P<0.01)。同时对照组在扩宫、进镜、操作中SBP与HR指标比术前下降,均有统计学差异(P<0.05)。TCI组术中血浆效应室浓度维持在(1.7~2.3)μg/ml。结论在宫腔镜手术的麻醉中,TCI技术能明显减少异丙酚的用药总量及平均用量,术中血浆效应室浓度维持在(1.7~2.3)μg/ml。

Objective To investigate the clinical effects of propofol target-controlled infusion （TCI） in hysteroscopic surgery.Methods There were 100 cases underwent hysteroscopic surgery with 26 ～42 years old,46 ～ 60 kg weight,and ASA Ⅰ to Ⅱ,were divided into two groups randomly.Fentanyl was infused by 2 μg/kg in all patients when disinfection.In the control group,1% propofol was firstly injected with 2 ～ 3 mg/kg,and then was used 20 ～ 30 mg fractionally according to the patient＇s expression and body movements to deepen the anesthetic effects.In the TCI group,propofol was infused by the Diprifusor system （Graseby 3500） according to the propofol TCI plasma concentration（MASH mode）,with the initial target plasma concentration （Cp） of 2μg/ml,and the sleep concentration of the observer＇s assessment of alertness-sedation scale （OAAS） ≤2.Results In the control group,the total and average propofol dosage was（391.3 ± 74.5） mg and （0.21 ± 0.08） mg/kg respectively,which were significantly higher than the （209.7 ± 83.0） mg and （0.11 ± 0.02）mg/kg of the control group.In the control group,the SBP and HR were lower than pre-operation at the point of cervical enlarging,hysteroscope inputting,and intrauterine procedures.The targeted effectsite concentration in TCI group maintained at（1.7 ～ 2.3） μg/ml.Conclusion In the anesthesia of hysteroscopy surgery,TCI technology can significantly reduce the total and average propofol dosage,and the targeted effect-site concentration should maintain at（1.7 ～ 2.3） μg/ml.