比较丙泊酚和雷米芬太尼用于乳腺活检手术清醒镇静的临床效果。

择期拟行单侧乳腺活检手术的患者40例，ASAⅠ~Ⅱ级，年龄18~60岁，随机分为丙泊酚组和雷米芬太尼组，各20例。在丙泊酚组，开始输注速度为2 mg·kg^-1·h^-1维持5 min后，如手术尚未开始则改为1 mg·kg^-1·h^-1，手术开始后维持2 mg·kg^-1·h^-1至术毕。在雷米芬太尼组，起始输注速度为0.1 μg·kg^-1·min^-1，5 min后降为0.05 μg·kg^-1·min^-1，维持至术毕。手术开始时使用1%利多卡因局部浸润麻醉，分别在局麻浸润和深部组织切除时进行疼痛评分（VAS）和清醒/镇静评分（OAA/S）。记录术后完全清醒（OAA/S评分为5分）时、术后30 min镇痛评分及术后并发症。

两组在局麻浸润和深部组织切除时的VAS和OAA/S评分差异无统计学意义，术中追加局麻药及SpO₂<90%的例数差异无统计学意义。雷米芬太尼组中的7例以及丙泊酚组的1例患者术中RR<8次/min，经语言唤醒后迅速缓解，组间差异有统计学意义（P<0.05）。术后30 min镇痛评分和术后恶心发生率组间差异无统计学意义。

丙泊酚和雷米芬太尼在乳腺活检术中均具有良好的镇静作用,但雷米芬太尼抑制呼吸频率的作用较强。

To compare the sedation effects of propol and remifentanil during breast biopsy under monitored anesthesia care(MAC).

Forty patients undergoing single-lateral breast biopsy were randomly assigned to propofol group and remifentanil group, with 20 patients in each group. In propofol group, and infusion was initiated 2 mg·kg^-1·h^-1, then decreased to 1 mg·kg^-1·h^-1 5 minutes later before operation, and maintained 2 mg·kg^-1·h^-1 during operation. In remifentanil group, and infusion was initiated 0.1 μg·kg^-1·min, then decreased to 0.05μg·kg^-1·min^-1 until end of procedure. The pain was evaluated with a ten-point visual analogue scale(VAS) and the sedation was evaluated with OAA/S scale during local anesthetic infiltration and deep tissue dissection. The awake time after operation(OAA/S score was 5), the pain scores 30min after operation and any postoperative complications were recorded.

The pain scores and sedation scores were similar between two groups. Seven patients in remifentanil group and one patient in propofol group experienced a decline in respiratory rate lower than 8 bpm(P<0.05), but correction was rapid following verbal instruction.

Both propofol and remifentanil provide good sedation druing breast biopsy under monitored anesthesia care, but remifentanil decrease respiratory rate significantly.