摘要
目的观察不同剂量地佐辛复合异丙酚用于宫颈锥切术的临床效果和安全性。方法宫颈锥切术病人80例(ASAⅠ～Ⅱ级),年龄20～60岁,随机分成D1、D2、D3、F组,每组20例。4组病人手术开始前10min启动异丙酚靶控输注,起始浓度为3.0mg/L,术中根据BIS(40～50)调整异丙酚靶浓度(每次0.3mg/L)。待病人入睡后放置鼻咽通气道。手术开始前5min,D1、D2、D3组分别静脉注射地佐率0.10、0.15、0.20mg/kg,F组静脉注射芬太尼1μg/kg。记录各组病人麻醉诱导前(T0)、入睡后(T1)、用地佐辛或芬太尼5min后(T2)、扩宫颈时(T3)、手术结束时(T4)以及呼之睁眼时(T5)的心率(HR)、平均动脉压(MAP)、呼吸频率(RR)、血氧饱和度(SpO2)、脑电双频谱指数(BIS),同时记录手术时间、苏醒时间及术后不良反应。结果 4组病人各时间点HR、MAP比较,差异无显著性(P>0.05);T1与T0比较HR、MAP、RR、SpO2、BIS下降,差异有统计学意义(F=4.327～2 744.193,q=3.600～10.500,P<0.05)。T2、T3时,F组RR、BIS值与D1、D2组比较差异有统计学意义(q=6.776～60.999,P<0.01),D3组BIS值与D1、D2组比较差异无统计学意义(P>0.05),D3组RR与D1、D2组比较差异有统计学意义(q=2.323～5.006,P<0.05)。D2、D3组T1、T2、T3时HR、MAP、BIS比较差异无统计学意义(P>0.05);T2、T3时F组、D3组的SpO2明显下降(q=9.779～2 2.021,P<0.01)。术中体动发生率D1组大于其他3组(χ2=14.33,P<0.01);术后头晕、恶心、呕吐、呼吸抑制发生率D3组、F组大于D1组、D2组(χ2=11.87～17.55,P<0.01)。结论地佐辛复合异丙酚可安全用于宫腔镜手术,其中以0.15mg/kg地佐辛复合异丙酚效果最佳。
Objective To investigate the effectiveness and safety of combining different-dose dezocine with propofol in in- travenous anesthesia for cervical conization （CC）. Methods Eighty patients（ASA Ⅰ or Ⅱ ）, aged 20-- 60 years, scheduled for CC were evenly randomized to groups D1, D2, D3, and F. At 10 rain before starting surgery, the propofol target controlled infu- sion was started, with initial concentration of 3.0 rag/L, which was adjusted during surgery （0.3 mg/L, each time） according to BIS （40-50）. A nasopharyngeal airway was placed when the patient fell asleep. At 5 min soon before surgery, Ⅳ dezocine of 0.10, 0.15 and 0.20 mg/kg was given to patients in groups D1, D2 and D3, respectively, to those in group F, Ⅳ fentanyl of 1 μg/ kg was offered. HR, MAP, RR, SpO2, and BIS were recorded before anesthesia induction （To）, at asleep （T1）, 5 rain after ad- ministration of dezocine or fantanyl （T2）, at dilatation of cervix （T3）, at the end of surgery （T4）, and opened eyes responding to call （T5）, as well as the operation time and postoperative adverse reactions. Results The differences of HR and MAP in differ- ent time point among the four groups were not significant （P〉0.05） ; a comparison between T1 and T0 showed that HR, MAP, RR, SpO2, and BISF at T1 declined （F=4.327--2 744.193 ,q=3.600--10.500,P〈0.05）, but as for group comparison the differ- ences were not significant （P〉0.05）. At T2 and T3, the differences of RR, BIS between group F and groups D1 and D2 were sig nificant （q = 6.776-60.999, P〈0.01）, the difference of BIS in D3 was not significant as compared with that in groups D1 and D2, but that of RR in D3 was significant with that in groups D1 and D2 （q=2.323-5.006,P〈0.05）. The HR, MAP and BIS at T1, T2 and T3 were not significantly different between groups D2 and D3 （P〉0.05）, and at T2 and T3, the SpO2 in groups F and D3 markedly dropped （q = 9.779-22.021, P 〈0.01）. The incidence rate of body movement was higher in group D1 than that in groups D2, D3 and F （χ2 = 14.33 ,P〈0.01） and that of postoperative adverse reactions and respiratory depression in groups D3 and F were higher than that in groups D1 and D2. Conclusion Combination of dezocine with propofol is safe for hysteroseopic surgery, of which, the dose of 0.15 mg/kg dezocine combined with propofol was the best in the four groups investigated.
出处
《齐鲁医学杂志》
2013年第5期410-413,共4页
Medical Journal of Qilu
