CAJ | 학술논문

目的比较不同剂量雷米芬太尼复合异丙酚在门诊无痛人工流产术中的应用,并讨论其恰当配伍剂量.方法 90例ASA Ⅰ级早期妊娠需人工流产的患者,随机分成A、B、C 3组,静脉推注咪唑安定1mg,随后静脉输注异丙酚8 mg/(kg·h),3 min,再静脉输注雷米芬太尼3 min[A组0.06 μg/(kg·min),B组0.1 μg(kg·min),C组0.15 μg(kg·min)],开始手术,如患者出现明显体动,增加雷米芬太尼输注速度0.05 μg/(kg·min),3 min后再次开始手术.两药均持续输注至手术负压吸引结束.观察平均动脉压(MAP)、心率(HR)、脉搏氧饱和度(SpO2)、脑电双频指数(BIS)、呼吸次数(RR)、潮气量(VT)、呼气末二氧化碳分压(PET CO2)的变化,以及各组的起效时间、手术时间、苏醒时间、镇静评分以及不良反应等.结果 A、C组镇静评分差异有统计学意义[(3.90±0.97)级与(4.90±0.85)级,t=4.24,P＜0.01],A组3例出现明显体动反应.所有患者给药后MAP、HR、BIS较基础值均有下降,且随着雷米芬太尼剂量的增大,C组心率明显减慢(P＜0.05或P＜0.01),A组在手术开始时MAP、HR、BIS升高,组间差异有统计学意义(P＜0.05或P＜0.01).呼吸均有不同程度的变慢、变浅,RR,VT较基础值下降,PETCO2逐渐升高(P＜0.05或P＜0.01),出现呼吸抑制:A组2例,B组4例,C组10例(其中出现呼吸停顿＞3 min 5例).所有患者面罩吸氧,SpO2没有明显下降.雷米芬太尼的其他不良反应如肌肉强直、恶心、呕吐等发生率低,3组比较差异无统计学意义(P＞0.05).90例患者麻醉满意度为100%.结论雷米芬太尼0.1 μg/(kg·min)、异丙酚8 mg/(kg·h)为恰当配伍剂量,适合于门诊无痛人流麻醉的要求,但要严密监测生命体征,防止心动过缓和呼吸抑制的发生,必备辅助通气和气管插管的设备及抢救药品,以保证患者的安全.
목적 비교불동제량뢰미분태니복합이병분재문진무통인공유산술중적응용,병토론기흡당배오제량.방법 90례ASA Ⅰ급조기임신수인공유산적환자,수궤분성A、B、C 3조,정맥추주미서안정1mg,수후정맥수주이병분8 mg/(kg·h),3 min,재정맥수주뢰미분태니3 min[A조0.06 μg/(kg·min),B조0.1 μg(kg·min),C조0.15 μg(kg·min)],개시수술,여환자출현명현체동,증가뢰미분태니수주속도0.05 μg/(kg·min),3 min후재차개시수술.량약균지속수주지수술부압흡인결속.관찰평균동맥압(MAP)、심솔(HR)、맥박양포화도(SpO2)、뇌전쌍빈지수(BIS)、호흡차수(RR)、조기량(VT)、호기말이양화탄분압(PET CO2)적변화,이급각조적기효시간、수술시간、소성시간、진정평분이급불량반응등.결과 A、C조진정평분차이유통계학의의[(3.90±0.97)급여(4.90±0.85)급,t=4.24,P＜0.01],A조3례출현명현체동반응.소유환자급약후MAP、HR、BIS교기출치균유하강,차수착뢰미분태니제량적증대,C조심솔명현감만(P＜0.05혹P＜0.01),A조재수술개시시MAP、HR、BIS승고,조간차이유통계학의의(P＜0.05혹P＜0.01).호흡균유불동정도적변만、변천,RR,VT교기출치하강,PETCO2축점승고(P＜0.05혹P＜0.01),출현호흡억제:A조2례,B조4례,C조10례(기중출현호흡정돈＞3 min 5례).소유환자면조흡양,SpO2몰유명현하강.뢰미분태니적기타불량반응여기육강직、악심、구토등발생솔저,3조비교차이무통계학의의(P＞0.05).90례환자마취만의도위100%.결론 뢰미분태니0.1 μg/(kg·min)、이병분8 mg/(kg·h)위흡당배오제량,괄합우문진무통인류마취적요구,단요엄밀감측생명체정,방지심동과완화호흡억제적발생,필비보조통기화기관삽관적설비급창구약품,이보증환자적안전.
Objective To compare different dose of remifentanil combined with propofol for painless abortion and approach to an appropriate dose of remifentanil.Methods Ninety pregnant women with ASA 1 were randomly divided into three groups(n=30)before administrating remifetanil,a bolus midazolam 1 mg was injected inminutes later.These two drugs did not stop administration until three minutes before the end of negative suction.MAP,HR,SpO2,BIS,RR,VT,PET CO2 were monitored.The onset,operation and recovery time,sedation score and adverse reaction were recorded.Results Sedation scores were significantly different between group A and C [(3.90±0.97)and(4.90±0.85),t=4.24,P＜0.01].Three cases in group A were found moving.MAP,HR,BIS decreased as compared witll baseline.HR reduced significantly in group C(P＜0.05,P＜0.01).Respiratory movement was lower and shallower.RR,VT decreased compared to preoperative one.PET C02 increased gradually (P＜0.05,P＜0.01).There were two cases of respiratory depressing in group A,four cases in group B and ten cases in group C(five cases apnea more than three minutes).All patients used oxygen mask to maintain SpO2＞95%.Incidence of adverse reactions such as chest titanic,nausea and vomiting,itching were of no difference among three groups(P＞0.05).All patients were satisfied with anesthesia.Conclusion The appropriate infusing dose of remifetory devices such as oxygen mask and monitoring life signs are very important to prevent respiratory depress and bradycardia during operation.