瑞芬太尼复合丙泊酚靶控输注在门诊隆乳术中的应用

目的探讨胸部美容手术行非气管插管全身麻醉中,不同浓度瑞芬太尼复合丙泊酚靶控输注的量效关系。方法选择ASAI-Ⅱ级行乳晕切口假体植入隆乳术女性患者,根据诱导期瑞芬太尼效应室靶浓度(0、1.0、1.5ng/mL)分为3组(n=20):C组(单纯丙泊酚组);REF1组(丙泊酚复合1.0ng/mL瑞芬太尼组);REF2组(丙泊酚复合1.5ng/mL瑞芬太尼组)。观察并记录患者不同时间点的血压、心率、脉搏氧饱和度及丙泊酚、瑞芬太尼的效应室浓度以及诱导期和维持期丙泊酚、瑞芬太尼用量和麻醉过程呼吸抑制、体动等不良反应,术后随访患者对麻醉的满意度。结果各组患者在不同时间点的血压、心率、脉搏氧饱和度、麻醉期间不良反应发生率的差异均无统计学意义(P>0.05),患者对麻醉满意率为100%;达到口头反应消失时,C组丙泊酚效应室浓度和诱导时间明显高于其余两组(P<0.05),且REF1和REF2组间比较无统计学意义(P>0.05)。结论小剂量(1.0～1.5ng/mL)瑞芬太尼复合丙泊酚靶控输注可满足胸部美容手术非气管插管全身麻醉需求,并且没有剂量依赖性效应。

Application of target-controlled infusion of propofol and remifentanil in augmentation mammaplasty

Objective To evaluate the dose-effect relationship in the target controlled infusion using propofol and different remifentanil concentrations in augmentation mammaplasty.Methods With the effect-site concentration of remifentanil during induction phase,sixty ASA Ⅰ and Ⅱ patients undergoing prosthesis implantation were divided into three groups: Group C,Group REF1 and Group REF2(the effect-site concentration of remifentanil was 0,1.0 and 1.5 ng/mL,respectively).The blood pressure,heart rate,SpO2,the effect-site concentrations of remifentanil and propofol,the doses of remifentanil and propofol in induction and maintenance phase,and the incidence of adverse reactions(respiratory depression,body/limb movement) were recorded.The patients’ satisfaction with anesthesia was followed up after surgery.Results The blood pressure,heart rate,SpO2,and incidence of adverse reactions were not significantly different in the three groups(P>0.05).All of the patients were satisfied with anesthesia.The effect-site concentrations of propofol and the induction time were distinctly higher in Group C than in the other two groups(P<0.05).But there was no significant difference between Group REF1 and Group REF2(P>0.05).Conclusion The target controlled infusion of propofol combined with remifentanil of low dose(1.0-1.5 ng/mL) can meet the clinical needs of general anesthesia during augmentation mammaplasty.