瑞芬太尼复合丙泊酚麻醉在人工流产术中的应用研究

目的 探讨瑞芬太尼复合丙泊酚在无痛人工流产术中的麻醉效果.方法 选择2011年3～4月解放军第三○九医院门诊人工流产术患者120例为研究对象,随机分成三组,每组各40例.P组静注2.5 mg/kg丙泊酚;R1组1.5 mg/kg丙泊酚＋1.0 μg/kg瑞芬太尼;R2组1.5 mg/kg丙泊酚＋2.0 μg/kg瑞芬太尼.术中患者躁动则追加丙泊酚1.0 mg/kg.观察术中心率（HR）、平均动脉压（MAP）、脉搏血氧饱和度（SpO2）的变化,术后视觉模拟评分（VAS）、满意度及不良反应的发生率.结果 ①P组术中HR低于术前,差异有统计学意义（P＜ 0.05）;R1和R2组患者术中HR和MAP低于术前（P＜ 0.05或P＜ 0.01）,也显著低于P组患者（P＜ 0.05）;R2组术中HR明显低于R1组,差异有统计学意义（P＜0.05）.②术后VAS评分R1组[（1.32±1.12）分]和R2组[（1.10±1.03）分]均低于P组[（3.30±1.30）分],差异均有统计学意义（均P＜ 0.05）;患者满意率R1组（95％）和R2组（95％）均明显高于P组（65％）,差异均有统计学意义（均P＜ 0.05）;术中体动发生率R1组（10.0％）和R2组（7.5％）均明显低于P组（32.5％）,差异均有统计学意义（均P＜ 0.05）;术中呼吸抑制发生率P组（17.5％）和R1组（25.0％）均明显低于R2组（47.5％）,差异均有统计学意义（均P＜ 0.05）.结论 丙泊酚1.5 mg/kg联合1μg/kg瑞芬太尼可安全用于无痛人工流产手术中,麻醉效果好,术后宫缩疼痛轻.

The study of Remifentanil combined Propofol anesthesia in induced abortion

Objective To investigate the effect of Remifentanil combined with Propofol anesthesia in induced abortion.Methods 120 patients with artificial abortion operation from March to April in 2011 in the 309th Hospital of PLA were selected as study objects,and they were randomly divided into three groups：patients were given the Propofol 2.5 mg/kg as group P,patients were given the Propofol 1.5 mg/kg followed by Remifentanil 1.0 μg/kg as group R1,and patients were given the Propofol 1.5 mg/kg followed by Remifentanil 2.0 μg/kg as group R2.A bolus of 1 mg/kg Propofol was given the move restlessly patients during the operation.The change of heart rate （HR）,mean arterial pressure （MAP）and pulse oxygen saturation （SpO2） during the operation were monitored.The patients satisfaction,visual analogue scale （VAS） and adverse effects after operation were recorded.Including respiratory depression and patient writhe were recorded.Results ① HR of patients in group P during operation was lower than that before operation,the difference was statistically significant （P ＜ 0.05） ; HR and MAP of patients in group R1 and R2 during operation were lower than those in group R1 before operation （P ＜ 0.05 or P ＜ 0.01） and lower than those in group P during operation （P ＜ 0.05） ;HR of patients in group R2 during operation was lower than that in group R1 during operation,the difference was statistically significant （P ＜ 0.05）.②VAS of patients after operation in group R1 [（1.32±1.12） scores] and group R2 [（1.10±1.03） scores] were significantly lower than that in group P [（3.30±1.30） scores],the differences were statistically significant （all P ＜ 0.05）; the incidence of patients＇ satisfaction in group R1 （95％） and group R2 （95％） were significantly higher than that in group P （65％）,the differences were statistically significant （all P ＜ 0.05）,the incidence of patient writhe in group R1 （10.0％） and group R2 （7.5％） were significantly lower than that in group P （32.5％）,the differences were statistically significant （all P ＜ 0.05）,the incidence of respiratory depression in group P （17.5％） and group R1 （25.0％） were significantly lower than that in group R2 （47.5％）,the differences were statistically significant （all P ＜ 0.05）.Conclusion Intravenous Propofol 1.5 mg/kg combined with Remifentanil 1 μg/kg is safe and effective for anesthesia during induced abortion and decreases the degree of postoperative uterine pain.