丙泊酚/瑞芬太尼不同输注模式对日间肛肠手术病人麻醉效应与呼吸循环功能的影响

Anaesthetic,ventilation and hemodynamic effects of different infusing mode of propofol/remifentanil on outpatient anorectal surgery

目的 观察自主呼吸情况下丙泊酚 /瑞芬太尼不同输注模式对日间肛肠手术病人麻醉效应与呼吸循环功能的影响。方法 6 0例ASAⅠ～Ⅱ级择期行肛肠手术的病人随机分为三组 ,每组 2 0例 :A组病人丙泊酚以麻醉剂量输注并辅以少量瑞芬太尼 ;B组病人以瑞芬太尼为主 ,丙泊酚以镇静剂量输注 ;C组为对照组 :0 5 %布比卡因 10mg行蛛网膜下腔阻滞麻醉。观察并记录术中病人HR、MBP、SpO2 、PETCO2 、手术肌松程度、术中需补注丙泊酚的量以及手术结束后出恢复室的时间等。结果 三组病人术中的SpO2 、手术肌松程度、出恢复室的时间及A、B两组术中需补注丙泊酚的量差异无显著意义 ;A、B两组病人术中HR、MBP及RF均在正常范围内 (P <0 0 5 ) ;B组PETCO2 与A组和C组比较显著升高 (P <0 0 5 )。结论 日间肛肠手术中丙泊酚 /瑞芬太尼静脉输注同样可取得与蛛网膜下腔阻滞麻醉相当的麻醉效应 ,但以丙泊酚麻醉剂量输注、瑞芬太尼为辅 (小于 4 μg·kg-1·h-1)的输注模式对病人的呼吸与循环功能影响小 ,使用更加安全。

Objective The purpose of this study was to evaluate the anaesthetic,ventilation and hemodynamic effects of different infusing mode of propofol/remifentanil on outpatient anorectal surgery.Methods Sixty ASA Ⅰ～Ⅱ patients aged 21～52yr needing outpatient anorectal surgery were randomly allocated to three equal groups.In group A,patients were infused with high(anaesthetic)-dose propofol/low-dose remifentanil.In group B,patients were infused with low(sedation)-dose propofol/high-dose remifentanil.In group C(control grop),patients were received 10mg bupivacaine for spinal anesthesia.HR,MBP,SpO 2,RF,PETCO 2,anaesthetic effect,dose of addtional propofol at the different time during the operation and the time for transfering the patient out of recovery room were recorded respectively.Results SpO 2,anaesthetic effect and the time for transfering the patient out of recovery room were not significantly different.HR,MBP and RF during operation in both group A and B were significantly lower compared with pre-anaesthetic values,but all of them were within the normal ranges(P<0.05).The doses of addtional propofol in group A and B were not significantly different.PETCO 2 in group B was significantly higher than those in group A and C(P<0.05).Conclusion During outpatient anorectal surgery,proper dose of propofol and remifentanil could provide as safe and effective anaesthesia as spinal block,the infusing mode of high(anaesthetic)-dose propofol/low-dose remifentanil may be more safe to use.