Sizlan A, Cekmen N, Bedir S, Yanarates O, Ozhan M O, Cosar A
Gulhane Military Medical Faculty, Departmentsof Anesthesiology, Ankara, Turkey.
Bratisl Lek Listy. 2011;112(7):380-4.
The aim of this study is to compare the efficiency of propofol+remifentanil to propofol+alfentanil in reducing pain in patients with urinary system stones undergoing outpatient Extracorporeal Shock Wave Lithotripsy (ESWL).
In this prospective study, 30 patients, ASA (American Society of Anesthesiologist) I-II, who are 18-60 years old and undergoing Extracorporeal Shock Wave Lithotripsy for urinary system stones were included. Patients were randomly selected for either propofol+remifentanil (Group PR) or propofol+alfentanil treatment (Group PA). Propofol was given at a dose 1 mg/kg, and then 5mg doses were given to maintain a BIS (Bispectral Index) level 60-70. Remifentanil (0.2 microg/kg (-1) bolus dose and later 0.02 microgkg(-1) min(-1) infusions) was given to the group PR and alfentanil (bolus dose 7 microgkg(-1) and later with 0.7 microgkg(-1) min(-1) infusions) was given to the group PA. If needed, the patients might use 10 ig remifentanil and 50 ig alfentanil bolus doses in group PR and PA using patient controlled analgesia (PCA) device. ECG, SpO2, BIS levels and arterial blood pressures were monitored and recorded. Patients were evaluated with Ramsay Sedation Level Evaluation Scale and with Modified Aldrete Scoring System during and after the procedure. VAS was given to patients to mark their pain level on this scale at the end of the procedure.
The values at pre-induction and post- induction in each group were statistically different but difference did not exist between the PR and PA groups.
We concluded that both methods may be successfully used for patients undergoing ESWL (Tab. 6, Rief. 29).
本研究旨在比较丙泊酚+瑞芬太尼与丙泊酚+阿芬太尼在减轻门诊接受体外冲击波碎石术（ESWL）的泌尿系统结石患者疼痛方面的效果。
在这项前瞻性研究中，纳入了30例年龄在18至60岁、ASA（美国麻醉医师协会）分级为I-II级且正在接受泌尿系统结石体外冲击波碎石术的患者。患者被随机分为丙泊酚+瑞芬太尼组（PR组）或丙泊酚+阿芬太尼治疗组（PA组）。丙泊酚以1mg/kg的剂量给药，然后以5mg的剂量给药以维持脑电双频指数（BIS）水平在60-70。PR组给予瑞芬太尼（0.2μg/kg负荷剂量，随后以0.02μg·kg⁻¹·min⁻¹输注），PA组给予阿芬太尼（负荷剂量7μg·kg⁻¹，随后以0.7μg·kg⁻¹·min⁻¹输注）。如有需要，PR组和PA组的患者可使用患者自控镇痛（PCA）装置给予10μg瑞芬太尼和50μg阿芬太尼负荷剂量。监测并记录心电图、脉搏血氧饱和度、BIS水平和动脉血压。在手术期间和术后，使用Ramsay镇静水平评估量表和改良Aldrete评分系统对患者进行评估。在手术结束时，让患者使用视觉模拟评分法（VAS）在该量表上标记其疼痛程度。
每组诱导前和诱导后的数值在统计学上有差异，但PR组和PA组之间不存在差异。
我们得出结论，两种方法均可成功用于接受ESWL的患者（表6，参考文献29）。
