异丙酚、芬太尼及瑞芬太尼在无痛人工流产中的应用

目的比较单独使用异丙酚、异丙酚联合芬太尼以及异丙酚联合瑞芬太尼在无痛人工流产中的麻醉效果、麻醉深度、苏醒时间、异丙酚用量以及对患者术中呼吸、循环的影响。方法 180例拟行无痛人工流产术的患者随机分为异丙酚组、异丙酚联合芬太尼组和异丙酚联合瑞芬太尼组,每组60例。异丙酚组异丙酚血浆靶浓度为8.0 mg.L-1;异丙酚联合芬太尼组输注异丙酚前静脉注射芬太尼1.0μg.kg-1,异丙酚血浆靶控浓度为5.5 mg.L-1;异丙酚联合瑞芬太尼组静脉注射1.0μg.kg-1瑞芬太尼后,异丙酚血浆靶控浓度为5.5 mg.L-1。监测给药时(T1)、术中(T2)、呼之睁眼时(T3)平均动脉压(MAP)、心率(HR)、脉搏血氧饱和度(SpO2)及脑电双频指数(BIS)值的变化,记录异丙酚的总剂量及患者诱导、唤醒时间,并对3组镇痛效果进行评估。结果给药后,3组患者MAP均有下降,与异丙酚联合瑞芬太尼组相比,异丙酚组术中(T2)血压下降更加明显(P<0.05),而与异丙酚联合芬太尼组比较差别无统计学意义(P>0.05)。与其他2组相比,异丙酚组在呼之睁眼时(T3)的心率明显较快(P<0.05),而在术中(T2)时的心率,异丙酚联合瑞芬太尼组明显低于异丙酚组(P<0.05),3组之间,术前、术中、术后SpO2比较差别无统计学意义(P>0.05)。3组患者给药后BIS值均明显下降,T2异丙酚联合瑞芬太尼组BIS值稍高于异丙酚组(P<0.05),但与异丙酚联合芬太尼组相比,差别无统计学意义(P>0.05)。异丙酚组诱导时间明显短于异丙酚联合芬太尼组和异丙酚联合瑞芬太尼组(P<0.05);而异丙酚联合芬太尼组诱导时间与异丙酚联合瑞芬太尼组比较差别无统计学意义(P>0.05)。异丙酚联合瑞芬太尼组唤醒时间明显短于异丙酚组和异丙酚联合芬太尼组(P<0.05),而异丙酚组与异丙酚联合芬太尼组唤醒时间比较差别无统计学意义(P>0.05)。异丙酚组异丙酚用药总量明显大于异丙酚联合芬太尼组和异丙酚联合瑞芬太尼组(P<0.05);而异丙酚联合芬太尼组与异丙酚联合瑞芬太尼组比较差别无统计学意义(P>0.05)。3组手术时间比较差别均无统计学意义(P>0.05)。异丙酚联合芬太尼组和异丙酚联合瑞芬太尼组术中镇痛效果明显优于异丙酚组(P<0.05);而异丙酚联合芬太尼组和异丙酚联合瑞芬太尼组镇痛效果比较差别无统计学意义(P>0.05)。结论在无痛人工流产中,异丙酚联合芬太尼或者瑞芬太尼镇痛效果好,可以减少异丙酚用药量,且异丙酚联合瑞芬太尼可以缩短患者唤醒时间。

Application of propofol, fentanyl and remifentanil in cases of painless artificial abortion

Objective To compare the anesthetic effect,anesthesia depth,recovery time,total propofol consumption and its effect on patients′ respiration and circulation of propofol alone,propofol plus fentanyl and propofol plus remifentanil in the process of painless artificial abortion.Methods One hundred and eighty patients for painless artificial abortion were randomly divided into three groups:propofol group,propofol plus fentanyl group and propofol plus remifentanil group,60 patients in each group.The target plasma concentration of propofol in propofol group was 8.0 mg·L-1.In propofol plus fentanyl group,1.0 μg·kg-1 fentaini were injected intravenously before the infusion of propofol,and the target plasma concentration of propofol was set as 5.5 mg·L-1.In propofol plus remifentanil group,1.0 μg·kg-1 remifentanil were injected intravenously before the infusion of propofol,and the target plasma concentration of propofol was also set as 5.5 mg·L-1.Mean arterial pressure(MAP),heart rate(HR),pulse oxygen saturation(SpO2),and bispectral index(BIS)at administration of the drugs(T1),during operation(T2) and eyes opening moment(T3) were monitored,and total propofol consumption,induction time,and recovery time were recorded during the operation.Analgesic effect were valued after operation in three groups.Results After administration of the drugs,MAP of all the three groups decreased.During operation(T2),the blood pressure of propofol group decreased obviously compared with that of propofol plus remifentanil group(P<0.05),but showed no significant difference compared with that of propofol plus fentanyl group(P>0.05).HR of propofol group at eyes opening moment(T3)was obviously faster than those of the other two groups(P<0.05).However,HR of propofol plus remifentanil group during operation(T2)was dramatically slower than that of propofol group(P<0.05).The SpO2 in all the three groups during the whole operation process showed no statistical differences(P>0.05).After drugs administration,BIS value in all the three groups decreased obviously.During operation,BIS value of propofol plus remifentanil group was slightly higher than that of propofol group(P<0.05),and showed no statistical differences,compared with that of propofol plus fentanyl group(P>0.05).Induction time between propofol plus fentanyl and propofol plus remifentanil groups showed no signaficant difference(P>0.05),and were both longer than that of propofol group(P<0.05).Awaking time between propofol and propofol plus fentanyl groups showed no significant difference(P>0.05),and were both longer than that of propofol plus remifentanil group(P<0.05).The total consumption of propofol between propofol plus fentanyl and propofol plus remifentanil group showed no signaficant difference(P>0.05),and were both larger than that of propofol group(P<0.05).The operation time in all three groups appeared no statistical differences(P<0.05).The analgesia effect between propofol plus fentanyl group and propofol plus remifentanil group showed no signaficant difference(P>0.05),and were both better than that of propofol group(P<0.05).Conclusion In the process of painless artificial abortion,propofol plus fentanyl or remifentanil have obviously advantages on the aspect of analgesia effect and drug consumption compared with propofol alone.In addition,considering of the recovery time propofol plus remifentanil has the most advantage in all the three groups.