意识指数监测下瑞芬太尼或舒芬太尼复合丙泊酚在妇科短小手术中的比较

Comparison of propofol combined with remifentanil or sufentanil in gynecological short surgery under the guidance of index of consciousness

目的观察和比较在脑电意识指数(index of consciousness,IoC)监测下,丙泊酚复合舒芬太尼或瑞芬太尼在妇科短小手术中的镇痛效果和术后恢复质量。方法选择妇科短小手术患者150例,年龄18~65岁,BMI 18~28 kg/m^2,ASAⅠ或Ⅱ级,随机分为舒芬太尼组(S组)和瑞芬太尼组(R组),每组75例。麻醉开始后以10 mg/s的速度静注丙泊酚,待镇静深度(IoC1)达到40~60时S组静注舒芬太尼0.5μg/s,R组静注瑞芬太尼5μg/s,至麻醉深度(IoC2)在30~50时开始手术。术中IoC1>60或体动影响手术时予以丙泊酚0.5~1.0 mg/kg,当IoC2>50时R组予以瑞芬太尼5μg,S组予以舒芬太尼0.5μg。记录术中丙泊酚和阿片类药物用量、苏醒时间和眩晕情况等。结果 S组术中舒芬太尼用量为(0.12±0.01)μg/kg,R组术中瑞芬太尼用量为(0.41±0.03)μg/kg。两组患者术中体动率、丙泊酚用量差异无统计学意义。在苏醒即刻和PACU离室时,R组眩晕率和眩晕程度均明显低于S组(P<0.01)。结论瑞芬太尼镇痛效果完善,术后眩晕感轻微,恶心呕吐发生率低,较舒芬太尼更适于妇科短小手术。

Objective To compare the analgesic effect and postoperative recovery quality of propofol combined with sufentanil or remifentanil in gynecological short surgery under the guidance of index of consciousness(IoC). Methods A total of 150 patients, aged 18-65 years, BMI 18-28 kg/m^2, ASA physical status Ⅰ or Ⅱ, undergoing gynecological short surgery were randomly divided into sufentanil group(group S) and remifentanil group(group R), with 75 cases in each group. Following anesthesia, propofol was intravenously injected at the rate of 10 mg/s. In group S, sufentanil was intravenously injected at 0.5 μg/s;in the group R, remifentanil was intravenously injected at 5 μg/s, and the operation began when IoC1(sedation) was 40-60 and IoC2(analgesia) was 30-50. Propofol 0.5-1.0 mg/kg was given during the operation when IoC1 > 60 or body movement interfered the operation, remifentanil 5 μg was given in the group R and sufentanil 0.5 μg in the group S when IoC2 > 50. Intraoperative propofol and opioid dosages, recovery time, and rate of dizziness were recorded. Results The intraoperative dosage of remifentanil was 0.12 ± 0.01 μg/kg in group S and 0.41 ± 0.03 μg/kg in group R. No statistically significant difference was observed in intraoperative body movement rate and propofol dosage between the two groups. The rate and the extent of dizziness in group R were significantly lower than those in group S(P < 0.01) at the moment of awakening and leaving the PACU. Conclusion Remifentanil exhibits satisfactory analgesic effect, mild postoperative dizziness and low incidence of nausea and vomiting. Remifentanil is more suitable for gynecological short surgery than sufentanil.