瑞芬太尼复合异丙酚或依托咪酯麻醉用于外阴白色病变聚焦超声治疗的研究

目的 比较瑞芬太尼复合异丙酚或依托咪酯麻醉用于外阴白色病变聚焦超声治疗的安全性和可行性.方法 择期行外阴聚焦白色病变超声治疗的患者60例,随机分为依托咪酯组（E组）和异丙酚组（P组）,每组30例.所有患者持续静脉输注0.1 μg·kg^-1·min^-1瑞芬太尼,待输注瑞芬太尼2 min后,E组患者缓慢推注0.3 mg/kg的依托咪酯,P组患者缓慢静注1 mg/kg的异丙酚,如患者体动,分别追加依托咪酯0.15 mg/kg 或异丙酚0.5 mg/kg.全程监测记录患者的心率（HR）、平均动脉压（MAP）、脉搏氧饱和度（SpO2）、呼吸频率（RR）和Ramsay镇静（RSS）评分以及手术医师满意度.结果 给药后的各个时相点P组的MAP和HR明显低于E组（P〈0.05）,P组呼吸暂停、心动过缓、低血压和注射部位痛的发生率要显著高于E组（P〈0.01）,而肌阵挛发生率E组要显著高于P组（P〈0.01）,手术医师的满意度两组间无统计学差异.结论 依托咪酯复合瑞芬太尼麻醉用于外阴白色病变的聚焦超声治疗,与异丙酚复合瑞芬太尼相比,患者呼吸循环更稳定,不良反应发生率明显降低.

Comparison of propofol.remifentanil and etomidate-remifentanil anesthesia applied to focused ultrasonictherapy for patients with white lesions of vulva

Objective To compare the safety and feasibility of remifentanil-etomidate and remifentanil- propofol in patients with with lesions of vulva undergoing focused ultrasound therapy. Methods Sixty cases were equally divided into two groups randomly. Patients in group E received etomidate-remifentanil anesthesia and patients in group P received propofol-remifentanil anesthesia. All of the cases received remifentanil 0. 1 μg·kg^-1·min^-1 by tintravenous infusion. After two minutes, patients in group E were slowly injected 0. 3 mg/kg etomidate, patients in group P were slowly injected 1 mg/kg propofol. 0. 15 mg/kg etomidate or 0. 5 mg/kg propofol were injected additionally if the patients moved. The heart rate （ HR）, mean arterial pressure （ MAP）, pulse oxygen saturation （SPO2） ,respiratory rate （ RR）, the Ramsay sedation scale （RSS） score and surgeon satisfaction were recorded. Results At different time points, MAP and HR in group P was significantly lower than the group E （ P 〈 0. 05）, and the incidence of apnea, bradycardia, hypotension, and injection site pain was significantly higher in group P than group E （ P 〈0.01 ） ,muscle clonus incidence of group E was significantly higher than group P （ P 〈0.01 ）. Surgeon satisfaction between the two groups were not significantly different. Conclusions Compared with propofol- remifentanil anesthesia, the respiration and circulation of patients with white lesions of vulva undergoing focused ultrasound therapy with etomidate-remifentanil anesthesia are more stable,less incidence of adverse reactions.