单纯丙泊酚及复合瑞芬太尼靶控输注用于无痛人工流产术的比较

目的比较丙泊酚复合瑞芬太尼靶控输注与单纯丙泊酚靶控输注用于无痛人工流产(人流)术的效果,探讨合理的静脉麻醉方法。方法80例美国麻醉医师协会(ASA)Ⅰ级接受无痛人流术的病人,分为两组,单纯丙泊酚靶控输注(TCI)组(P组)和丙泊酚复合瑞芬太尼TCI组(PR组),每组40例。P组:丙泊酚血浆靶浓度为6～7mg/L;PR组:丙泊酚血浆靶浓度为3.5～4mg/L、瑞芬太尼血浆靶浓度为1.8～2μg/L。待病人意识消失(睫毛反射消失、呼之不应)后开始手术,扩张宫颈结束时停止给药。结果①麻醉效果PR组优于P组(P<0.05)。②PR组诱导时间(1.1±0.4)min,明显短于P组(P<0.05),PR组丙泊酚总剂量(1.8±0.4)mg/kg,明显少于P组(P<0.01)。③苏醒期躁动、兴奋多语P组发生率分别为55%、50%,PR组未发生(P<0.01)。④两组麻醉后血压均明显下降(P<0.01),扩宫时最低,停药后很快回升,负压吸引时恢复至麻醉前水平(P>0.05),各时段脑电双频指数(BIS)值明显下降(P<0.01,P<0.05),负压吸引时最低,以后逐渐回升。结论在无痛人流术中,丙泊酚复合瑞芬太尼靶控输注优于单纯丙泊酚靶控输注,麻醉效果好、诱导时间短、显著减少丙泊酚用量、减少不良反应,是一种安全、合理的静脉麻醉方法。

Comparison of propofol alone and propofol plus remifentanil given by target-controlled infusion for analgesic artificial abortion

Objective To compare the effects of target controlled infusion (TCI) of remifentanil and/or propofol on analgesic artificial abortion.Methods Eighty patients of ASA Ⅰ (American society of anesthesiologists,gradeⅠ),aged 21～40 undergoing analgesic artificial abortion were divided into two group (each 40 patients):TCI propofol (group P ) and TCI remifentanil propofol (group PR).The patients in group P were given propofol at a plasma concentration of 6～7 mg/L;the plasma concentration of propofol was set at 3 5～4 mg/L and remifentanil at 1 8～2 μg/L in group PR.The operations were started after the patients lost consciousness (no response to voice command and loss of eyelash reflex) and TCI stopped when dilating cervix uteri was over.Results ①The anesthetic effect was significantly better in group PR than that in group P (P<0.05).②Induction time was significantly shorter in group PR (1 1±0 4) min than in group P (P<0.05 ),the total amounts of propofol were much less in group PR (1.8±0.4) mg/kg than those in group P (P<0.01 ).③Group P had restlessness and hyperphasia during reanimation stage,accounting for 55% and 50% respectively;while group PR had nothing occurred (P<0.01).④The two groups all had a postanesthetic drop in blood pressure (P<0.01),with the deepest value during cervical dilatation,but soon going up again after withdrawing the anesthetics;during the vacuum suction the patient had a blood pressure back to prenarcotic level (P>0 05).BIS (bispectral index) was significantly lower (P<0.01,P<0.05) with the minimum during vacuum suction,then rising again gradually.Conclusion In painless artificial abortion the target controlled infusion of propofol plus remifentanil is superior to that of propofol alone;the former showed a better anesthetic effect,a shorter induction time,a considerable reduction in propofol′s dose and adverse reaction (if any);it is a safe,reasonable vein anesthesia.