麻醉医生控制与患者自控丙泊酚镇静用于冲击波碎石术的比较。

Anesthesiologist-controlled versus patient-controlled propofol sedation for shockwave lithotripsy.

作者信息

Alhashemi Jamal A, Kaki Abdullah M

机构信息

Department of Anesthesia and Critical Care, King Abdulaziz University Hospital, P.O. Box 31648, Jeddah 21418, Saudi Arabia.

出版信息

Can J Anaesth. 2006 May;53(5):449-55. doi: 10.1007/BF03022616.

DOI:10.1007/BF03022616

PMID:16636028

Abstract

PURPOSE

To compare anesthesiologist-controlled sedation (ACS) with patient-controlled sedation (PCS), with respect to propofol requirements, sedation, and recovery, in patients undergoing extracorporeal shockwave lithotripsy for urinary calculi.

METHODS

Sixty-four patients were randomized, in this double-blind study, to receive propofol sedation according to one of two regimens: infusion of 200 microg.kg(-1) .min(-1) for ten minutes reduced thereafter to 50-150 microg.kg(-1) .min(-1) titrated by an anesthesiologist, according to patient response (group ACS), or propofol administered by patient-controlled analgesia (bolus dose 300 microg.kg(-1), lockout interval three minutes, no basal infusion), (group PCS). All patients received midazolam 10 microg.kg(-1) iv and fentanyl 1 microg.kg(-1) iv preoperatively, followed by fentanyl infused at a rate of 0.5 microg.kg(-1) .hr(-1) throughout the procedure. Sedation and analgesia were assessed using the A-line ARX index and visual analogue scale, respectively. Psychomotor recovery and readiness for recovery room discharge were assessed using the Trieger dot test and postanesthesia discharge score, respectively. Patient satisfaction was assessed on a seven-point scale (1-7).

RESULTS

In comparison to group PCS, patients in group ACS received more propofol (398 +/- 162 mg vs 199 +/- 68 mg, P < 0.001), were more sedated (A-line ARX index: 35 +/- 16 vs 73 +/- 16, P < 0.001), experienced less pain (visual analogue scale: 0 +/- 0 vs 3 +/- 1, P < 0.001), and were more satisfied (median [Q1, Q3]: 7 [7, 7] vs 6 [6, 7], P < 0.001). In contrast, patients in group PCS had faster psychomotor recovery (Trieger dot test median [Q1, Q3]: 8 [4, 16] vs 16 [12, 26] dots missed, P = 0.002) and achieved postanesthesia discharge score >/=9 earlier (median [Q1, Q3]: 40 [35, 60] vs 88 [75, 100] min, P < 0.001) compared with group ACS.

CONCLUSION

In comparison to PCS for patients undergoing extracorporeal shockwave lithotripsy, propofol/fentanyl ACS is associated with increased propofol administration, deeper sedation levels, and greater patient comfort. However, ACS is associated with slower recovery and a longer time to meet discharge criteria, when compared to PCS.

摘要

目的

在接受体外冲击波碎石术治疗尿路结石的患者中，比较麻醉医生控制镇静（ACS）与患者自控镇静（PCS）在丙泊酚需求量、镇静效果及恢复情况方面的差异。

方法

在这项双盲研究中，64例患者被随机分为两组，根据以下两种方案之一接受丙泊酚镇静：以200μg·kg⁻¹·min⁻¹的速度输注10分钟，之后根据患者反应由麻醉医生将速度降至50 - 150μg·kg⁻¹·min⁻¹（ACS组）；或通过患者自控镇痛给予丙泊酚（负荷剂量300μg·kg⁻¹，锁定时间3分钟，无基础输注）（PCS组）。所有患者术前静脉注射咪达唑仑10μg·kg⁻¹和芬太尼1μg·kg⁻¹，然后在整个手术过程中以0.5μg·kg⁻¹·hr⁻¹的速度输注芬太尼。分别使用A-line ARX指数和视觉模拟评分评估镇静和镇痛效果。分别使用Trieger点试验和麻醉后出院评分评估精神运动恢复情况及准备好从恢复室出院的情况。采用七点量表（1 - 7）评估患者满意度。

结果

与PCS组相比，ACS组患者接受的丙泊酚更多（398±162mg对199±68mg，P<0.001），镇静程度更深（A-line ARX指数：35±16对73±16，P<0.001），疼痛更轻（视觉模拟评分：0±0对3±1，P<0.001），且更满意（中位数[四分位数间距1，四分位数间距3]：7[7，7]对6[6，7]，P<0.001）。相比之下，PCS组患者的精神运动恢复更快（Trieger点试验中位数[四分位数间距1，四分位数间距3]：漏点8[4，16]个对16[12，26]个，P = 0.002），且与ACS组相比更早达到麻醉后出院评分≥9（中位数[四分位数间距1，四分位数间距3]：40[35，60]分钟对88[75，100]分钟，P<0.001）。