异丙酚联合瑞芬太尼清醒镇静对呼吸功能的影响

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15min后，P组：给予3mg／（kg·h）异丙酚连续输注，R组：给予6ug／（kg·h）瑞芬太尼连续输注，P＋R组：给予3ug／（kg·h）瑞芬太尼和1．5mg／（kg·h）异丙酚同时连续输注，对照组：给予0．3ml／（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1ug／（kg·h）增减，P组以0.5mg／（kg·h）增减，P＋R先增减瑞芬太尼0．5ug／（kg·h）如果仍未达到目标再调整异丙酚0．25mg／（kg·h）增减。记录于入室后（T0）、输注药物前（T1）、输注药物后5min（T2）、10min（T3）、15min（T4）、30min（T5）、子宫切除时（T6）、药物停止输注时（T7）、药物停止输注后10min（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15min，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）ug／（kg·h），P＋R组瑞芬太尼（2．7±0．4）ug／（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有品著意义的降低（P〈0．05）?

Effect of propofol combinded with remifentanil for conscious sedation on respiratory function during hysterectomy under continous spinal epidural anesthesia

Objective To evaluate the effect of propofol combinded with remifentanil for conscious sedation on respiratory function during hysterectomy under continous spinal epidural anesthesia. Methods After informed consent was given,80 ASA Ⅰ-Ⅱ patients undergoing hysterectomy under CSEA were randomly individed into four groups with 20 patients in each ：control group（ group C ） , propofol group（ group P） , Remifentanil group （group R）, propofol and remifentanil group（ group P ＋ R）. The patients received continous intraveous infusion without loading dose,propofol 3 mg/（ kg · h） （Group P）or remifentanil 6 ug/（ kg · h） （Group R）or propofol 1.5 mg/（kg · h） and remifentanil 3 ug/（kg · h） （Group P ＋ R） or saline 0.3 ml/（ kg · h） （ group C）. Depth of sedation was maintained at the Obsever＇ s Assessment of Ahertness/Sedation Scale （OAA/S） = 3 by adjusting the rate of hypnotics. The value of SpO2 , spontaneous Respiration Rate （sRR） were recorded before anesthesia （To 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 infusion was propofol 2.8 ±0.6 mg/（ kg · h） in group P,remifentanil（6.4 ± 1.5） ug/（ kg · h）in group R,P＋R remifentanil（2.7±0.4）ug/（kg· h）and propofo（1 1.6±0.6）mg/（kg· h）in group P＋ R. SpO2 was decreased in R group at T5 , T6 as compared with T0 （ P 〈 0.05 ）. sRR was significantly decreased at T4 ,T5 as compared with T0 in group R（P 〈0.05）. PaCO2 was significantly increased at T5 as compared with T0 in group R,P,P ＋ R（P 〈 0.05）, The incidence of respirato