靶控输注丙泊酚与联合瑞芬太尼用于无痛人工流产术的临床效果比较

目的:比较靶控输注丙泊酚及联合瑞芬太尼用于无痛人工流产(人流)术的麻醉效果及不良反应,寻找人流术合理的静脉麻醉方法。方法:80例ASAⅠ级接受无痛人流术者随机分为单纯丙泊酚靶控输注组(A组)和丙泊酚复合瑞芬太尼靶控输注组(B组),每组40例。A组患者单纯靶控输注丙泊酚,B组先以瑞芬太尼血浆浓度2μg/L输注3 min后,开始输注丙泊酚。丙泊酚初始靶浓度为2.0 mg/kg,稳定1 min后每次递增0.5~1 mg/kg直至意识消失。术中调整丙泊酚靶浓度值,维持麻醉完善,手术结束后停药。结果:麻醉效果B组优于A组(P<0.005)。B组诱导时间明显短于A组(P<0.01),B组丙泊酚总剂量明显少于A组(P<0.01)。苏醒期躁动、兴奋多语A组发生率明显高于B组(P<0.05)。两组麻醉后血压均明显下降(P<0.01),扩宫时最低,术毕恢复至麻醉前水平(P>0.05)。两组受术者满意度VAS评分差异无统计学意义(P>0.05),手术医师满意度VAS评分B组高于A组(P<0.01)。结论:在无痛人流术中,靶控输注丙泊酚复合瑞芬太尼的麻醉诱导时间短,丙泊酚用量显著减少,不良反应减少,效果优于单纯丙泊酚靶控输注,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 in analgesic artificial abortion

Objective： To compare the analgesic effects of target-controlled infusion （TCI） of propofol alone and propofol plus remifentanil in artificial abortion. Methods： Eighty cases of ASA-Ⅰ （ American society of anesthesiologists, grade Ⅰ ）, who were undergoing artificial abortion, were randomly divided into TCI propofol group （A） and TCI remifentanil-propofol group（B）. Each group consisted of 40 cases. Group A were given only propofol,while Group B were given remifentanil at 2 μg/L plasma concentration first, and 3 minutes later,propofol was infused. The initial plasma concentration of propofol was set at 2.0 mg/kg and 1 minute later the concentration was added 0.5 - 1 mg/kg each time gradually until the patients lost consciousness. During the operation, the concentration of propofol was adjusted to reach the good state of anesthesia. Results：The anesthetic effect was significantly better in group B than in group A （P 〈 0.005）. The induction time was much shorter in group B than in group A （ P 〈 0.01 ）, and the total amount of propofol used was much less in group B than in group A （P 〈 0.01 ）. Group A had more restlessness and hyperphasia during the reanimation stage than group B （P 〈 0. 005）. Both groups had a postanesthetic drop in blood pressure,which was the most obvious at the time when the uterus was extended,and resumed to normal after operation （ P 〈 0.01 ）. The patients＇ satisfaction degree showed no significant difference between the two groups （P 〉 0.05） ,while the surgeon＇s satisfaction degree to group B was significantly higher than to group A （P 〈 0.01 ）. Conclnsions： In painless artificial abortion, the TCI of propofol plus remifentanil is superior to that of propofol alone. The former shows a better anesthetic effect, a shorter induction time and a considerable reduction in propofol＇s dose and adverse reaction. It is a safe and reasonable vein anesthesia.