【摘要】 目的 觀察丙泊酚在重癥監護室（ICU） 外科術后對患者的鎮靜效果及作用。 方法 2006年7月-2008年7月，對行外科手術后在ICU觀察室采用丙泊酚鎮靜的45例患者的鎮靜效果、停藥蘇醒時間及給藥前后呼吸、循環參數的變化進行觀察，并與治療前進行比較。 結果 丙泊酚鎮靜起效快，鎮靜治療后大多數患者開始血壓有所下降（Plt;0.05）但不久恢復正常，所有患者心率、呼吸頻率、血氧飽和度無明顯變化（Pgt;0.05），停藥后蘇醒快。 結論 丙泊酚是外科術后患者較理想的鎮靜劑，但應根據患者情況調整給藥速度、劑量及時間。 【Abstract】 Objective To observe the sedative effect of propofol on the patients after surgical operations in intensive care unit (ICU). Methods Forty-five patients underwent the injection with propofol after surgical operations in ICU from July 2006 to July 2008. The sedative efficacy, recovery time after the propofol administration, and changes of respiratory, circulate parameter before and after medication were observed, which were compared with those before the treatment. Results The sedative reactive time of propofol was short. Most of the patients had decreased blood pressure after injection with propofol (Plt;0.05) but recovered soon. The heart rate, respiratory rate, and pulse oxygen saturation did not significantly changed (Pgt;0.05). The recovery time was short after propofol administration was stopped. Conclusion Propofol is an effective sedative for the patients after surgical operations in ICU, but the medicated speed, amount and time according to state of the patients should be adjusted.
目的:觀察丙泊酚靜脈泵注復合腰硬聯合麻醉于剖宮產術中的可行性及安全性。方法:50例ASA I~II級行擇期剖宮產術產婦,于L2-3行腰硬聯合麻醉,確定麻醉平面為T4-6,取出胎兒后靜脈緩推丙泊酚1mg/kg,然后2~4mg·kg-1·h-1靜脈泵入,連續監測平均動脈壓,心率,血氧飽和度,呼吸頻率。結果:腰硬聯合麻醉及靜脈推注負荷劑量丙泊酚后平均動脈壓降低,但無臨床意義。余心率,氧飽和度,呼吸頻率各時點無統計學差異。結論:丙泊酚復合腰硬聯合麻醉用于剖宮產術患者生命體征平穩,鎮靜效果良好。
摘要:目的:分析與比較七氟醚吸入麻醉和丙泊酚靜脈復合麻醉應用于三聚氰胺致嬰幼兒輸尿管結石手術的麻醉效果。方法:60例輸尿管結石患兒隨機分為七氟醚(Sev)組(n=30)和丙泊酚(Pro)組(n=30)。觀察并記錄誘導時間、氣管內插管時間、蘇醒時間、拔除氣管插管時間、PACU滯留時間。記錄麻醉誘導和蘇醒期的不良反應。另外記錄兩組病人誘導前、插管前、插管后3 min、5 min、15 min、30 min時點的血壓、心率、脈搏血氧飽和度(SPO2)。結果:七氟醚組誘導時間(63.2±6.9)s長于丙泊酚組(38.2±12.7)s,七氟醚組拔除氣管插管時間(11.9±4.7)min短于丙泊酚組(15.6±8.2)min,兩組相比有統計學意義(Plt;0.05)。七氟醚組躁動發生率53.3%顯著高于丙泊酚組13.3%(Plt;0.01)。七氟醚組在插管前、插管后各時點的血壓、心率與誘導前相比,差異無統計學意義(Pgt;0.05),丙泊酚組插管前、插管后3 min、5 min與誘導前相比血壓、心率顯著降低(Plt;0.05),與同時間點七氟醚組相比血壓顯著降低(Plt;0.05)。結論:兩種麻醉方法均可安全有效用于嬰幼兒輸尿管結石手術,七氟醚組血流動力學更平穩,但躁動發生率較高。Abstract: Objective: To analyze and compare sevoflurane with propofol for anesthesia in infants with Melamineinduced ureteral stone surgery. Methods: Sixty infants who were to undergo Melamineinduced ureteral stone surgery were randomly divided into sevoflurane (Sev) group (n=30) and propofol (Pro) group (n=30). Observe and record the induction of anesthesia time, intubation time, awakening time, time to extubation, time to stay at PACU. Record adverse effects during induction of anesthesia and the awake period. In addition, recorded BP, HR, SPO2 of two groups before induction and intubation, after 3min、5min、15min、30min after intubation. Results: Induction time ［（63.2 ± 6.9） s］ in sevoflurane group was longer than propofol group ［(38.2±12.7） s］,but extubation time ［（11.9 ± 4.7） min］ was shorter than propofol group ［(15.6 ± 8.2） min］, there was significantly different between two groups (Plt;0.05). The incidence of restlessness in sevoflurane group 53.3% was significantly higher than propofol group 13.3% (Plt;001). In sevoflurane group the BP, HR before intubation compare with after intubation has no significant difference (Pgt;0.05). Compared with before induction,the BP, HR before induction, after intubation 3 min, 5 min, decreased significantly (Plt;0.05) in propofol group.when compared the same point with sevoflurane group, blood pressure decreased significantly (Plt;0.05). Conclusion: Both propofol and sevoflurane can be used effectively and safely for anesthesia of ureteral calculi stone surgery in pediatric. The hemodynamics is more stable but restlessness is more common in sevoflurane group.
ObjectiveTo evaluate the feasibility and efficiency of patient-controlled analgesia and sedation (PCAS) with propofol and remifentanil for colonoscopy in elderly patients. MethodsSixty elderly patients preparing for painless colonoscopy between May and September 2015 were randomly allocated into PCAS group and total intravenous anesthesia (TIVA) group with 30 patients in each. In the PCAS group, the mixture of remifentanil and propofol at 0.6 mL/(kg·h) was pumped continuously after an initial bolus of 0.05 mL/kg mixture. The examination began three minutes after the infusion was finished. Patients could press the self-control button. Each bolus delivered 1 mL and the lockout time was 1 minute. In the TIVA group, patients received fentanyl at 1 μg/kg and midazolam at 0.02 mg/kg intravenously, and accepted intravenous propofol at 0.8-1.0 mg/kg two minutes later. The examination began when the patients lost consciousness. ResultsA significant decline of mean arterial blood pressure was detected within each group after anesthesia (P < 0.05). The decrease of mean blood pressure in the TIVA group was more significant than that in the PCAS group (P < 0.05). The heart rate, pulse oxygen saturation and respiratory rate decreased significantly after anesthesia in both the two groups (P < 0.05), while end-tidal CO2 increased after anesthesia without any significant difference between the two groups (P > 0.05). The induction time, time to insert the colonoscope to ileocecus, and total examination time were not significantly different between the two groups (P > 0.05). As for the time from the end of examination to OAA/S score of 5 and to Aldrete score of 9, the PCAS group was significantly shorter than the TIVA group (P < 0.05). ConclusionPCAS with remifentanil and propofol can provide sufficient analgesia, better hemodynamic stability, lighter sedation, and faster recovery compared with TIVA.
目的 觀察右美托咪啶復合丙泊酚靶控靜脈麻醉在纖維支氣管鏡檢查術中的麻醉效果。 方法 2010年12月－2012年4月，將60例行纖維支氣管鏡檢查術的患者隨機分為丙泊酚麻醉組（對照組）和右美托咪啶復合丙泊酚麻醉組（觀察組），每組各30例。觀察記錄不同時點平均動脈壓（MAP）、心率、呼吸次數（RR）、脈搏血氧飽和度（SpO2），鎮靜評分、手術時間、蘇醒時間、丙泊酚總用量、不良反應發生率及患者滿意度。 結果 所有患者均能順利完成操作，誘導入睡后觀察組MAP、心率下降（P＜0.05），丙泊酚總用量、不良反應發生率均少于對照組（P＜0.05），鎮靜評分優于對照組（P＜0.05）；兩組RR、SpO2、蘇醒時間、手術時間及患者滿意度差異無統計學意義（P＞0.05）。 結論 右美托咪定復合丙泊酚靶控輸注適用于纖維支氣管鏡檢查術麻醉，是一種更加安全有效的麻醉方法。
目的:比較七氟醚吸入麻醉和丙泊酚、瑞芬太尼靜脈麻醉用于小兒手術的臨床效果。方法:100例1～8歲的患兒隨機分為丙泊酚、瑞芬太尼組(A組)與七氟醚吸入組(B組）。麻醉誘導后,A組持續輸注丙泊酚和瑞芬太尼維持麻醉,B組吸入七氟醚維持麻醉。術中根據生命體征調整丙泊酚、瑞芬太尼的輸注速度及七氟醚的吸入濃度,記錄術中循環變化、術后麻醉恢復情況。結果:與B組相比,A組術中MAP下降明顯(Plt;005)。結論:與A組相比,B組術中生命體征控制平穩;術后清醒迅速、完全、平穩,拔管時間無明顯差異。
【摘要】 目的 探討腰硬聯合麻醉復合丙泊酚恒速輸注清醒鎮靜的可行性、理想的藥物劑量、術中知曉情況以及麻醉質量和效果。 方法 收集2009年3-12月480例美國麻醉醫師協會（ASA）Ⅰ～Ⅲ級擬在腰硬聯合麻醉下行下腹部、會陰部、下肢手術的患者480例，隨機分為咪達唑侖組（M組）、丙泊酚Ⅰ組（PA組）、丙泊酚Ⅱ組（PB組）、丙泊酚Ⅲ組（PC組），每組各120例。四組患者均于腰2-3或腰3-4行腰硬聯合麻醉，蛛網膜下腔注入輕比重0.2 %布比卡因12～15 mg，麻醉平面確切后，M組予以咪達唑侖0.04~0.06 mg/kg，PA組先予以負荷量丙泊酚0.50 mg/kg再以2.00 mg/（kg?h）劑量持續泵注，PB組予以負荷量丙泊酚0.75 mg/kg再以3.00 mg/（kg?h）劑量持續泵注，PC組予以負荷量丙泊酚1.00 mg/kg再以3.75 mg/（kg?h）劑量持續泵注。觀察患者給藥前（T0）、給藥1（T1）、3（T2）、5（T3）、10（T4）、30（T5）、60 min（T6）各時點血流動力學平均動脈血壓（MAP）、心率（HR）的變化、腦電雙頻指數（BIS）值及鎮靜評分、術中所看到的圖片的回憶及不良反應。 結果 各組在給予鎮靜藥后MAP、HR均有所下降，但測量值的變化在正常范圍內；在T3時間點，各組BIS值及鎮靜/警醒OAA/S評分降低，與T0比較，差異有統計學意義（Plt;0.05）；與其他3組比較，在T4、T5、T6時點PC組BIS值與OAA/S評分降低，差異有統計學意義（Plt;0.05），PC組的鎮靜遺忘滿意率高于其他3組；各組間未見發生嚴重的舌后墜、呼吸暫停和血氧飽和度（SpO2）lt;90%。 結論 在下腹部、下肢手術中，應用腰硬聯合麻醉復合1.00 mg/kg負荷量的丙泊酚繼而以3.75 mg/（kg?h）劑量持續泵注，可取得良好的鎮靜效果，不良反應小。【Abstract】 Objective To investigate the feasibility, ideal dose, intra-operative awareness as well as the quality and effectiveness of constant infusion of propofol under combined spinal-epidural anesthesia (CSEA) for conscious sedation. Methods A total of 480 patients at ASA grade Ⅰ-Ⅲ to be operated in the lower abdomen, perineum and lower limbs under CSEA from March to December 2009 were randomly divided into four groups: midazolam group (M group), propofol group Ⅰ (PA group), propofol group Ⅱ (PB group), and propofol group Ⅲ (PC group), with 120 patients in each group. All four groups of patients underwent CSEA at L2-3 or L3-4 and accepted pinal injection of 12-15 mg of 0.2% hypobaric bupivacaine. After the anesthetic plane was confirmed, patients in M group accepted 0.04-0.06 mg/kg of midazolam; patients in PA group accepted propofol at a loading dose of 0.50 mg/kg followed by continuous infusion at a dose of 2.00 mg/(kg?h); patients in PB group accepted propofol at a loading dose of 0.75 mg/kg followed by continuous infusion at a dose of 3.00 mg/(kg?h); patients in PC group accepted propofol at a loading dose of 1.00 mg/kg followed by continuous infusion at a dose of 3.75 mg/(kg?h). The change of hemodynamics including the mean arterial pressure (MAP) and the heart rate (HR), bispectral index (BIS) values, sedation scores, memory of pictures seen during operation and adverse effects before drug administration (T0), at minute 1 (T1), 3 (T2), 5 (T3), 10 (T4), 30 (T5) and 60 (T6) after drug administration were observed. Results MAP and HR decreased in all the four groups after administration of sedatives, but the changes of measured values were within normal ranges. BIS value and the Observer’s Assessment of Alertness and Sedation (OAA/S) scale decreased in all groups at T3, compared with those at T0 (Plt;0.05). Compared with the other 3 groups, BIS valueand OAA/S scale were significantly lower in PC group at T4, T5 and T6 (Plt;0.05), and the satisfaction rate of sedation and amnesia was much higher. No serious glossocoma, apnea and SpO2 below 90% was observed in all the four groups. Conclusion During the surgery of lower abdomen and lower limbs, application of CSEA combined with propofol at a loading dose of 1.00 mg/kg followed by continuous infusion at a dose of 3.75 mg/(kg?h) can achieve a good sedative effect, with little side effect.
【摘要】 目的 比較瑞芬太尼、丙泊酚、艾司洛爾用于支撐喉鏡手術氣管插管時患者的心血管反應。 方法 選取2009年1-3月就診的60例擬于全身麻醉下行擇期支撐喉鏡下聲帶息肉切除術的患者，隨機分為丙泊酚組、艾司洛爾組和瑞芬太尼組，每組20例。麻醉誘導采用咪達唑侖、芬太尼和丙泊酚，患者意識消失后給予琥珀膽堿。1 min后各組分別給予丙泊酚2 mg/kg、艾司洛爾1 mg/kg和瑞芬太尼1 μg/kg。30 s后進行氣管插管。記錄患者誘導前及插管前、插管后1、3、5 min的心率和血壓水平。 結果 各組插管前的收縮壓和心率較誘導前明顯降低，插管后1、3 min的收縮壓和心率較插管前升高（Plt;0.05)。丙泊酚組和艾司洛爾組插管后的收縮壓較瑞芬太尼組升高（Plt;0.05)。丙泊酚組插管后心率較瑞芬太尼組增加（Plt;0.05)。 結論 對行支撐喉鏡手術的患者，氣管插管前30 s給予1 μg/kg瑞芬太尼較2 mg/kg丙泊酚和1 mg/kg艾司洛爾能更有效地減輕氣管插管時的血流動力學反應。【Abstract】 Objective To assess the different effects of remifentanil, propofol, and esmolol on hemodynamic responses during intubation in CO2 laser endolaryngeal microsurgery (CO2-LELM). Methods A total of 60 patients aged from 18 to 65 years, admitted from January to March 2009 and scheduled to undergo elective CO2-LELM under general anesthesia for treatment of vocal cord polyp were randomly assigned to a propofol group, an esmolol group, and a remifentanil group. Anesthesia was induced with midazolam (0.015-0.02 mg/kg), fentanyl (1 μg/kg), and propofol (1 mg/kg). After the patients became unconscious, succinylcholine (1 mg/kg) was given one minute later. Then the patients in the three groups received propofol (2 mg/kg), esmolol (1 mg/kg), and remifentanil (1 μg/kg), respectively. Intubation was performed 30 secconds later. Heart rate (HR) and systolic blood pressure (SBP) were measured noninvasively before general anesthesia induction (baseline, Tb), just before intubation(Ti), and one, three, and five minutes after intubation (T1, T3, T5). Results The demographic data including age, sex and body weight were comparable in the three groups. Tracheal intubation caused significant increases in SBP and HR in all groups compared with Ti (Plt;0.05). After intubation, SBP in the propofol group and the esmolol group were significantly higher than that in remifentanil group (Plt;0.05), and HR in the propofol group was significantly higher than that in the remifentanil group (Plt;0.05). Conclusion In patients with CO2-LELM, remifentanil (1 μg/kg) administrated 30 seconds before intubation is maximal effective compared with propofol (2 mg/kg) or esmolol (1 mg/kg) in attenuating the hemodynamic responses to oraltracheal intubation.