目的 观察异丙酚联合不同剂量芬太尼对日间手术麻醉深度和血流动力学的影响,探索合适的芬太尼联合镇痛剂量。方法 选择门诊日间手术患者80例,随机分为4组。Ⅰ组静脉注射异丙酚至脑电双频指数(bispectral index,BIS)值降到50,Ⅱ、Ⅲ、Ⅳ组静脉注射芬太尼分别为0.50、0.75、1.00 μg/kg,然后Ⅱ、Ⅲ、Ⅳ组均缓慢推注异丙酚至BIS值降到50。术中根据患者对刺激的反应适量追加异丙酚,记录用药前(T₁)、睫毛反射消失时(T₂)、手术或操作开始(T₃)、手术或操作结束(T₄)、苏醒时(T₅)各时间点的BIS、心率(HR)、血压(BP)、动脉血氧饱和度(SpO₂)、心电图(ECG)。记录苏醒时间、肢体运动情况及异丙酚用药量。结果 Ⅱ、Ⅲ、Ⅳ组异丙酚用药量分别为(1.3±0.1)mg/kg、(1.2±0.1)mg/kg、(1.2±0.1)mg/kg,明显少于Ⅰ组(2.0±0.1)mg/kg,差异有统计学意义(P<0.01)。肢体运动反应Ⅱ、Ⅲ、Ⅳ组明显少于Ⅰ组,差异有统计学意义(P<0.05)。Ⅰ组BP、SPO₂下降较Ⅱ、Ⅲ、Ⅳ组显著,差异有统计学意义(P<0.05)。结论 芬太尼0.75 μg/kg联合异丙酚用于日间手术麻醉安全有效,苏醒时间短且费用低廉,是较为理想的联合用药麻醉选择。

Objective To study the offect of propofol combined with different doses of fentanyl on the depth of anesthesia and hemodynamics during outpatient surgery, seek for the suitable dose of compound fentanyl analgesia.Methods Eighty outpatient surgical patients (ASA Ⅰ~Ⅱ class)were randomly divided into four groups: propofol was simply used in group Ⅰ, fentanyl was intravenously injected 0.50 μg/kg in group Ⅱ, fentanyl was injected intravenously 0.75 μg/kg in group Ⅲ,fentanyl intravenously injected 1.00 μg/kg in group Ⅳ; then propofol was slowly injected intravenously in each group to the BIS (bispectral index) values to 50(disappearance of eyelash reflex), surgery began after 1 minute,and additional propofol according to response of the stimulation in patients, maintained BIS between 40-50.①The data of BIS,HR (heart rate), BP (blood pressure), SPO₂ (arterial oxygen saturation), and ECG (electrocardogram, ECG) were recorded at time of premedication disappearance of eyelash reflex, starting operation or surgical procedure, end of the operation and waking up.②Waking up time, body movements and propofol dose were also recorded.Results (1)T1-T4 BIS had no significant differences between four groups. Waking time and recovery time of orientation in group Ⅳ was prolonged than those in groups Ⅰ, Ⅱ, Ⅲ (P<0.05). (2) Propofol doses in group Ⅱ, Ⅲ, Ⅳ were obviously lower than that in group Ⅰ (P<0.01). Physical movements response in group Ⅱ, Ⅲ, Ⅳ were lower than that in group Ⅰ (P<0.05). (3) Decrease of NIBP, SPO₂ in group Ⅳ was more significant than in groups Ⅰ,Ⅱ, Ⅲ (P<0.05). Conclusions Intravenous anesthesia with fentanyl combined with propofol(0.75 μg/kg) is safe,effective, and inexpensive with short wakeing up time for outpatient surgery.