异丙酚联合瑞芬太尼清醒镇静对呼吸功能的影响(1)
【摘要】 目的 本研究拟通过异丙酚联合瑞芬太尼清醒镇静应用于腰硬联合麻醉下妇科手术中，观察其对呼吸功能的影响，评价其安全性。方法 80例ASAI-II级择期拟在腰硬联合麻醉下行子宫切除术的患者。将患者随机分为对照组20例(C组)、异丙酚组20例(P组)、瑞芬太尼组20例(R组)、瑞芬太尼联合异丙酚组20例(R+P组)。患者腰硬联合麻醉，调整麻醉平面达T6。蛛网膜下腔阻滞麻醉15 min后，P组：给予3 mg/(kg•h)异丙酚连续输注，R组：给予6 μg/(kg•h)瑞芬太尼连续输注，P+R组：给予3 μg/(kg•h)瑞芬太尼和1.5 mg/(kg•h)异丙酚同时连续输注，对照组：给予0.3 ml/(kg•h)生理盐水连续输注。输注过程中调整输注速度使患者OAA/S=3分。术毕停止输注药物，镇静过程中持续鼻导管吸氧。由于呼吸抑制或维持OAA/S评分需要调整药物剂量时，R组以1 μg/(kg•h)增减，P组以0.5mg/(kg•h)增减，P+R先增减瑞芬太尼0.5 μg/(kg•h)如果仍未达到目标再调整异丙酚0.25 mg/(kg•h)增减。记录于入室后(T0)、输注药物前(T1)、输注药物后5 min(T2)、10 min(T3)、15 min(T4)、30 min(T5)、子宫切除时(T6)、药物停止输注时(T7)、药物停止输注后10 min(T8)时点的SpO2、自主呼吸次数(sRR)，和呼吸抑制的发生率。于T0、T5、T8时点取动脉血行血气分析。药物停止输注后观察15 min，直至OAA/S评分为5分。用VAS评分法测定术中焦虑程度。结果 患者一般资料无差别。P组异丙酚平均输注速度为(2.8±0.6)mg/(kg•h)，R组瑞芬太尼平均输注速度为(6.4±1.5)μg/(kg•h)，P+R组瑞芬太尼(2.7±0.4)μg/(kg•h)异丙酚(1.6±0.6)mg/(kg•h)。四组患者的呼吸频率从T1时点较T0开始降低，但只有在R组的T4、T5时点较T0有显著意义的降低(P2的变化：C，P，P+R组患者的SpO2在各时点组间、组内比较无统计学差别(P>0.05)，R组中的T5、T6时点较T0有显著意义的下降。sRR的变化：瑞芬太尼组患者的sRR T4、T5较统计学意义降低(P0.05)。PaCO2在P组、R组、P+R组的T5时点较T0显著升高(P2,spontaneous Respiration Rate(sRR)were recorded before anesthesia(T0 baseline),before sedation(T1),after sedation 5 min(T2),10 min(T3),15 min(T4),30 min(T5),after hysterectomy(T6),stopping infusion(T7),stopping infusion 10 min(T8).pH,PaO2,PaCO2 were determined at T0,T5,T8.The incidence of respiratory depression was recorded during sedation.The scores of anxiety was measured with a visual analog scale.Results There was no significant difference in age,body weight,duration of sedation.The rate of infusionwas propofol 2.8±0.6mg/(kg•h)in group P,remifentanil(6.4±1.5)μg/(kg•h)in group R，P+R remifentanil(2.7±0.4)μg/(kg•h)and propofo(l 1.6±0.6)mg/(kg•h)in group P+R.SpO2 was decreased in R group at T5,T6 as compared with T0(P4,T5 as compared with T0 in group R(P2 was significantly increased at T5 as compared with T0 in group R,P,P+R(P<0.05).The incidence of respiratory depression was higher in group R than another groups(P<0.05).The scores of patients anxiety was higher in groupC than in group R,P,P+R(P<0.01).Conclusion The combination of propofol andremifentanil provided respiration stability,and a low scores of patients anxiety with a low risk of side effects in conscious sedation during hysterectomy under CSEA.
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