靶控输注丙泊酚行钬激光输尿管镜碎石术

目的研究靶控输注丙泊酚联合应用舒芬太尼用于钬激光经尿道输尿管镜碎石术的可行性和安全性。方法将30位择期行钬激光经尿道输尿管镜碎石术患者,ASAⅠ-Ⅱ级,随机分为两组,两组均于入室后静注舒芬太尼0.1μg.kg-1,给药后3min靶控输注丙泊酚,一组丙泊酚靶浓度为3μg.mL-1(G1组,n=15),另一组丙泊酚靶浓度为4μg.mL-1(G2组,n=15);待效应室浓度达预定值后开始操作,术中根据体动情况可单次追加丙泊酚,同时使术中BIS<60,若脉搏血氧饱和度低于90%给予面罩加压给氧。在麻醉中观察并记录血压、心率、脉搏血氧饱和度、BIS值、镇静分级(RAMSAY评分)、并发症发生率(呼吸抑制、血压下降、恶心、呕吐、咳嗽和躁动)以及丙泊酚用药总量、追加次数、意识恢复时间(从停丙泊酚至呼之睁眼及定向力恢复),并在两组间进行比较。结果两组患者镇静效果分级均为4～5分,G1组和G2组平均BIS值分别为59±10和56±13(P>0.05),均达到足够镇静深度。两组患者靶控至预定浓度后血压有明显下降,进镜时血压、心率、血氧饱和度与入室时组间比较差异无统计学意义(P>0.05),G1组与G2组辅助呼吸发生率为2/15和8/15(χ2:P=0.02)。G1组和G2组术中轻微体动的发生率分别为5/15和1/15(χ2:P=0.08)。G1组与G2组的呼之睁眼时间为(2.8±1.1)min和(8.3±3.0)min,定向力恢复时间为(7.6±1.9)min和(15.6±2.2)min(P<0.01)。丙泊酚总用药量分别为(225.5±77.7)mg和(342.5±72.6)mg(P<0.01)。术后随访表明对内镜操作均无记忆。结论本实验中舒芬太尼与丙泊酚复合麻醉,对于钬激光输尿管镜碎石术能达到足够的麻醉深度,两组麻醉剂量均具有安全性和可行性。靶控浓度3μg.mL-1组可减轻呼吸抑制、缩短术后清醒时间,同时节省丙泊酚用药总量。

Target Controlled Infusion of Propofol in Patients Undergoing Ureter Retrogression Lithotripsy

Objective To estimate the feasibility and safety of intravenous anesthesia by using target controlled infusion with propofol and sufentanil in patients undergoing ureter retrogression lithotripsy(URL) with holmium laser.Methods Thirty patients(ASA Ⅰ-Ⅱgrade),scheduled for URL,were randomly divided into two groups.All the patients received sufentanil 0.1 μg·kg^-1,3 minutes later,and then were administered by target controlled infusion of propofol.The target concentrations were 3 μg·mL^-1 in group 1(G₁,n=15)and 4 μg·mL^-1 in group 2(G₂,n=15),respectively.Operations began as soon as the effect site concentration achieved plateau.Bispectral Index(BIS) was controlled under 60 by propofol bolus delevery.In addition,when the operation was disturbed because of body movement,a few dosage of propofol would be delevered.Mask positive pressure ventilation was applied when pulse oxygen saturation(SpO₂) was lower than 90%.Blood pressure,heart rate,SpO₂ and BIS value were monitored.Other parameters such as sedation grade(RAMSAY),complications,total dosage and frequency of propofol bolus injection,time for recovery would also be compared between the two groups.Results The sedation grades of the two groups were both 4-5.BIS were 59±10 and 56±13,and there were no statistical difference between G₁ and G₂ groups.The incidence of mask ventilation were 2/15 in G₁ and 8/15 in G₂(χ²:P=0.02)respectively;the incidence of body movement were 5/15 in G₁ and 1/15 in G₂(χ²:P=0.08);time to open eyes with command was(2.8±1.1)minutes in G₁ and(8.3±3.0)minutes in G₂;time for recovery of directional judgment was(7.6±1.9)minutes in G1 and(15.6±2.2)minutes in G₂;total dosage of propofol given were(225.5±77.7)mg in G₁ and(342.5±72.6)mg in G₂;all of the 5 parameters mentioned above were statistically different between the two groups(P<0.01).Each patient had no memory during the operation.Conclusion The combined anesthesia of propofol and sufentanil in two groups are both good for URL,whereas there was less side-effects in the group with target concentration of 3 μg·mL^-1 than the other.