摘要
目的探索麻醉深度监测下不同剂量瑞芬太尼复合丙泊酚和依托咪酯在宫腔镜手术中的应用效果。方法180例行无痛宫腔镜检查或治疗的患者,按丙泊酚和依托咪酯静脉推注诱导复合静脉泵注不同剂量瑞芬太尼分为丙小组[丙泊酚复合瑞芬太尼0.05μg/(kg·min)]、丙中组[丙泊酚复合瑞芬太尼0.10μg/(kg·min)]、丙大组[丙泊酚复合瑞芬太尼0.15μg/(kg·min)]及依小组[依托咪酯复合瑞芬太尼0.05μg/(kg·min)]、依中组[依托咪酯复合瑞芬太尼0.10μg/(kg·min)]、依大组[依托咪酯复合瑞芬太尼0.15μg/(kg·min)],各30例。根据镇静指数[小波指数(WLi)>70]和镇痛指数(PTi)>70或体动时给予丙泊酚0.5 mg/kg或依托咪酯0.05 mg/kg,观察并比较六组患者各个时间点(麻醉前、诱导后、术始、术毕)平均动脉压(MAP)、心率(HR)、镇静指数、镇痛指数。结果麻醉前、诱导后、术始、术毕,丙小组MAP分别为(85.30±9.82)、(78.47±9.47)、(74.60±10.45)、(73.67±7.23)mm Hg(1 mm Hg=0.133 kPa),丙中组分别为(85.43±5.67)、(72.26±6.72)、(64.60±7.49)、(65.40±7.90)mm Hg,丙大组分别为(84.83±6.01)、(66.50±8.32)、(60.47±5.69)、(61.50±6.26)mm Hg,依小组分别为(86.60±6.69)、(83.50±7.25)、(83.43±7.01)、(86.37±5.25)mm Hg,依中组分别为(86.33±7.51)、(80.56±7.39)、(75.70±8.53)、(80.70±10.35)mm Hg,依大组分别为(84.66±5.26)、(71.90±7.32)、(67.00±5.04)、(69.87±6.34)mm Hg;麻醉前,六组MAP比较差异无统计学意义(P>0.05);诱导后、术始、术毕,丙中组、丙大组及依大组MAP均低于丙小组,丙大组MAP均低于丙中组,差异有统计学意义(P<0.05);诱导后、术始、术毕,丙小组、丙中组、丙大组MAP均低于相对应的依小组、依中组、依大组,差异有统计学意义(P<0.05)。麻醉前、诱导后,六组HR比较差异无统计学意义(P>0.05);术始、术毕,丙中组HR与依中组及丙大组HR与依大组比较差异无统计学意义(P>0.05);术始、术毕,丙大组HR低于丙中组和丙小组,依大组HR低于依小组和依中组,差异有统计学意义(P<0.05)。麻醉前,六组镇静指数比较差异无统计学意义(P>0.05);诱导后、术始、术毕,丙大组和丙中组镇静指数低于丙小组,丙大组镇静指数低于丙中组,差异有统计学意义(P<0.05);诱导后、术始、术毕,依大组和依中组镇静指数低于依小组,依大组镇静指数低于依中组,差异有统计学意义(P<0.05);诱导后,丙小组、丙中组、丙大组镇静指数分别低于相对应依小组、依中组、依大组,差异有统计学意义(P<0.05)。麻醉前,六组镇痛指数比较差异无统计学意义(P>0.05);诱导后、术始、术毕,丙大组、丙中组镇痛指数均低于丙小组,丙大组镇痛指数低于丙中组,差异有统计学意义(P<0.05);诱导后、术始、术毕,依大组、依中组镇痛指数均低于依小组,依大组镇痛指数低于依中组,差异有统计学意义(P<0.05)。结论0.10μg/(kg·min)瑞芬太尼复合丙泊酚或依托咪酯在宫腔镜手术中麻醉深度稳定,副作用少。丙泊酚复合瑞芬太尼较依托咪酯起效时间更快,镇静效果更满意,依托咪酯循环更稳定。
Objective To explore the application effect of different doses of remifentanil intravenous injection combined with propofol and etomidate in hysteroscopic surgery on depth of anesthesia monitoring.Methods 180 patients who underwent painless hysteroscopy or treatment were selected.According to intravenous injection induced by propofol and etomidate combined with remifentanil at different doses,they were divided into low-dose propofol group[propofol combined with remifentanil 0.05μg/(kg·min)],medium-dose propofol group[propofol combined with remifentanil 0.10μg/(kg·min)],high-dose propofol group[propofol combined with remifentanil 0.15μg/(kg·min)],low-dose etomidate group[etomidate combined remifentanil 0.05μg/(kg·min)],medium-dose etomidate group[etomidate combined remifentanil 0.10μg/(kg·min)],and high-dose etomidate group[etomidate combined remifentanil 0.15μg/(kg·min)],each with 30 cases.Propofol 0.5 mg/kg or etomidate 0.05 mg/kg were given according to the sedation index[wavelet index(WLi)>70]and pain threshold index(PTi)>70 or body movement;observation and comparison of the mean arterial pressure(MAP),heart rate(HR),sedation index,and analgesia index of the six groups of patients at each time point(before anesthesia,after induction,at the beginning of surgery and after surgery).Results Before anesthesia,after induction,at the beginning of surgery and after surgery,MAP of low-dose propofol group were(85.30±9.82),(78.47±9.47),(74.60±10.45),(73.67±7.23)mm Hg(1 mm Hg=0.133 kPa),medium-dose propofol group were(85.43±5.67),(72.26±6.72),(64.60±7.49),(65.40±7.90)mm Hg,high-dose propofol group were(84.83±6.01),(66.50±8.32),(60.47±5.69),(61.50±6.26)mm Hg,low-dose etomidate group were(86.60±6.69),(83.50±7.25),(83.43±7.01),(86.37±5.25)mm Hg,medium-dose etomidate group were(86.33±7.51),(80.56±7.39),(75.70±8.53),(80.70±10.35)mm Hg,and high-dose etomidate group were(84.66±5.26),(71.90±7.32),(67.00±5.04),(69.87±6.34)mm Hg.Before anesthesia,there was no significant difference in MAP among the six groups(P>0.05).After induction,at the beginning of surgery and after surgery,MAP of medium-dose propofol group,high-dose propofol group and high-dose etomidate group were lower than those of low-dose propofol group,and high-dose propofol group was lower than medium-dose propofol group.The difference was statistically significant(P<0.05).After induction,at the beginning of surgery and after surgery,MAP of low-dose propofol group,medium-dose propofol group and high-dose propofol group were lower than those of low-dose etomidate group,medium-dose etomidate group and high-dose etomidate group.The difference was statistically significant(P<0.05).There was no significant difference in HR among the six groups before anesthesia and after induction(P>0.05).At the beginning of surgery and after surgery,there was no significant difference in HR between medium-dose propofol group and medium-dose etomidate group,and high-dose propofol group and high-dose etomidate group(P>0.05).At the beginning of surgery and after surgery,HR in high-dose propofol group was lower than that in medium-dose propofol group and low-dose propofol group;HR in high-dose etomidate group was lower than that in low-dose etomidate group and medium-dose etomidate group;the difference was statistically significant(P<0.05).Before anesthesia,there was no significant difference in sedation index among the six groups(P>0.05).After induction,at the beginning of surgery and after surgery,the sedation index of high-dose propofol group and medium-dose propofol group were lower than those of low-dose propofol group,and high-dose propofol group was lower than medium-dose propofol group.The difference was statistically significant(P<0.05).After induction,at the beginning of surgery and after surgery,the sedation index of high-dose etomidate group and medium-dose etomidate group were lower than those of low-dose etomidate group,and high-dose etomidate group was lower than medium-dose etomidate group;the difference was statistically significant(P<0.05).After induction,the sedation index of high-dose propofol group,medium-dose propofol group and low-dose propofol group were lower than those of low-dose etomidate group,medium-dose etomidate group and high-dose etomidate group;the difference was statistically significant(P<0.05).Before anesthesia,there was no significant difference in analgesia index among the six groups(P>0.05).After induction,at the beginning of surgery and after surgery,the analgesia index of high-dose propofol group and medium-dose propofol group were lower than those of low-dose propofol group,and high-dose propofol group was lower than medium-dose propofol group;the difference was statistically significant(P<0.05).After induction,at the beginning of surgery and after surgery,the analgesia index of high-dose etomidate group and medium-dose etomidate group were lower than those of low-dose etomidate group,and high-dose etomidate group was lower than medium-dose etomidate group;the difference was statistically significant(P<0.05).Conclusion 0.10μg/(kg·min)remifentanil combined with propofol or etomidate has stable anesthesia depth and few side effects in hysteroscopic surgery.Propofol combined with remifentanil has faster onset time and more satisfactory sedation effect compared with etomidate,but etomidate is more stable in circulation.
作者
王良山
陈展明
高宝华
WANG Liang-shan;CHEN Zhan-ming;GAO Bao-hua(Huaqiao University Affiliated Xiamen Changgeng Hospital,Xiamen 361026,China)
出处
《中国现代药物应用》
2025年第4期23-27,共5页
Chinese Journal of Modern Drug Application
基金
厦门市科技局2021年科研项目(项目编号:3502Z20214ZD117)。
关键词
麻醉深度监测
瑞芬太尼
丙泊酚
依托咪酯
宫腔镜手术
Depth of anesthesia monitoring
Remifentanil
Propofol
Etomidate
Hysteroscopic surgery
