丙泊酚不同给药方式在输尿管支架拔除术中效果的比较

Comparative effects of different anesthetisa methods in ureteral stents removal surgery

目的比较丙泊酚三种给药方式在输尿管支架拔除术中的效果。方法选择行输尿管支架拔除术患者210例男性,年龄18~50岁,BMI20~30 kg/m2之间,ASA分级Ⅰ~Ⅱ级,随机分为三组,每组70例,三组患者均静脉推注舒芬太尼0.1μg/kg,A组2 min后匀速推注丙泊酚至患者入睡且睫毛反射消失后即刻开始手术;B组在给予舒芬太尼同时给予丙泊酚1 mg/kg,2 min后追加丙泊酚至睫毛反射消失后开始进行手术。C组同时用TCI泵注丙泊酚维持在Cpt 1.5μg/mL后开始进行手术;若手术开始时或后续操作中有明显体动反应则追加丙泊酚0.5 mg/kg。记录三组患者诱导前(T0)、手术开始前(T1)、输尿管镜入镜后(T2)和术毕(T3)时的HR、MAP,观察术中体动等反应,术毕清醒时间和丙泊酚用量。结果 T1与T0时刻相比A组的MAP、HR波动较大有统计学意义(P<0.05),B、C组的MAP、HR波动较小无统计学意义(P>0.05)。体动发生率A组23例、B组12例、C组11例,三组间体动发生率有统计学差异(P<0.05),B、C组间无差异(P>0.05)。呼吸抑制发生率A组25例、B组13例、C组10例。三组间呼吸抑制发生率有统计学差异(P<0.05),B、C组间无差异(P>0.05)。术毕清醒时间、丙泊酚用量比较三组有统计学差异(P<0.05)。结论对分次给药的用药方式在血压的影响、减少体动与呼吸抑制的发生率方面明显优于单次用药。分次给药的用药方式与TCI用药方式相似,但相比TCI方式用药量更少、苏醒时间更短。

Objective To compare the effect of three methods of anesthetisa in Ureteral stent removal surgery. Method A total of210 patients whose age were from 18-50 years old, BMI were 20 to 30 and ASA were Ⅰ ~ Ⅱ,and who asked for ureteral stents removal operations from June 2016 to December 2016,were selected. They were randomly divided into three groups, each group with 70 patients.Group A was received Shu Fentani 0.1 ug/kg infusion slowly, and two minutes later combined propofol intravenously. when the patients＇ consciousness lost and eyelash reflex disappeared, the surgery was started. Group B was received 0.1 ug/kg of intravenous Shu Fentani infusion and 1 mg/kg of propofol simultaneously. The surgery was supposed to start two minutes later when group B was received additional propofol until eyelash reflex disappeared. Propofol was administered by TCI at plasma concentration of 1.5 ug/mL simultaneously in group C. When necessary（cough or movement） additional propofol 0.5 mg/kg was added to enhance and maintain anesthesia. HR,BP and Sp O2 were recorded before induction（T0） before insert（T1） cystoscope passing throught prostate（T2） and after procedure（T3）. Body movement,recovery time and total dosage of propofol were observed and recorded. Results Compared with T0, the fluctuation of MAP and HR in group A was statistically significant（P〈0.05）, and the fluctuation of MAP and HR in group B and C was insignificant（P〈0.05）. There were 23 cases in group A, 12 cases in group B and 11 cases in group C, and there was a significant difference in body movement between three groups（P〈0.05） and there was no significant difference between groups B and C（P〈0.05）. The incidence of respiratory depression in group A was 25 cases, B group was 13 cases, C group was 10 cases. Respiratory depression among three groups had a statistically significant difference（P〈0.05）, but no difference between B and C group（P〈0.05）. There was no statistic different in recovery time and propofol usage among three groups（P〈0.05）. Conclusion The administration mode of sub-administration is obviously better than single-dose administration in the influence of blood pressure and reduction of the incidence of body movement and respiratory depression.The administration mode of sub-administration is similar to the TCI administration mode, but the dosage is less and the wake-up time is shorter than that of TCI.