舒芬太尼联合丙泊酚清醒镇静用于无痛人工流产术的有效性观察

目的探讨舒芬太尼联合丙泊酚清醒镇静在无痛人T流产术中应用的安全性和可行性。方法择期行人工流产术的早孕患者160例，完全随机分为全身麻醉组和清醒镇静组，各80例。全身麻醉组静脉单次给予芬太尼1μg/kg、丙泊酚1．5～2．5mg／kg，待患者睫毛反射消失、呼之不应时即进行操作；清醒镇静组给予舒芬太尼0．175μg/kg、丙泊酚0．8～1．0mg／kg，待患者警觉／镇静评分达3分时即进行操作，2组患者在宫内操作结束时停止给予任何药物。监测患者的平均动脉压（MAP），脉搏血氧饱和度（SpO2）和HR，并记录手术时间、定向力恢复时间，同时记录术中不良反应及术后患者和产科医生满意度、疼痛视觉模拟评分法（VAS评分）等情况。结果与全身麻醉组相比，清醒镇静组患者的MAP、HR、SpO2在诱导后无明显变化，术中患者的血流动力学也比较稳定，全身麻醉组患者的低血压、低氧血症的发生率明显高于清醒镇静组[27．50％（22／80）比3．75％（3／80），12．50％（10／80）比1．25％（1／80），P〈0．05]，体动反应低于清醒镇静组[1．25％（1／80）比11．25％（9／80），P〈0．05]；2组的手术时间、术后患者和产科医生的满意度评分，差异无统计学意义（P〉0．05），而清醒镇静组患者的恢复时间明显短于全身麻醉组[（4．6±1．1）min比（12．5±1．0）min，P〈0．05]。结论舒芬太尼联合丙泊酚清醒镇静能够安全有效地用于无痛人工流产术，患者血流动力学稳定，而且恢复时间短。

Effect of conscious sedation propofol combined with sufentanil on painless artificial abortion

Objective To investigate the safety and effect of propofol with sufentanil for conscious sedation in patients undergoing painless abortion. Methods One hundred and sixty women with first trimester pregnancy scheduled for artificial abortion were randomly allocated into general anesthesia group and conscious sedation group. In general anesthesia group, patients were induced with fentanyl 1 μg/kg and propofol 1.5-2.5 mg/kg, and the procedure was started after lost of eyelash reflex and the patients were responseless to commands ; while in conscious sedation group, patients were sedated with sufentanil 0. 175 μg/kg and propofol 0.8-1.0 mg/kg, and the operation was started when the score 3 of OAA/S was achieved. Physiologic parameters such as mean arterial pressure, pulse oxygen, heart rate were recorded, and procedure time, as well as orientation recovery time were also recorded. All side-effects during the operation and the patient and obstetrician satisfactory scores after operation were finished. Results Patients in conscious sedation group had no significant change in mean arterial pressure, pulse oxygen and heart rate during operation, whereas patients in general anesthesia group suffered a higher incidence of side-effects such as hypotension and hypoxemiaE 27. 50% （22/80） vs 3.75% （3/80）, 12.50% （10/80） vs 1.25% （1/80） , P 〈 0.05 ~ which need intervention. There were no statistical difference between the two groups in procedure time, patient and obstetrician＇ satisfactory and visual analogue scale score （P 〉 0.05 ） , however, patients in conscious sedation group had a much shorter recovery timeE （4.6 ± 1.1 ） rain vs （ 12.5 ± 1.0） min, P 〈 0.051- Conclusions Propofol combined with sufentanil can be used for conscious sedation effectively and safely during artificial abortion, and it can provide much better hemodynamic stability, less respiratm3, depression, and shorter recovery time.