异丙酚联合芬太尼对无痛人工流产术患者血氧饱和度影响的临床观察

目的观察异丙酚、芬太尼在无痛人工流产术中对患者血氧饱和度的影响，了解联合用药对呼吸系统的影响。方法选择要求终止妊娠的患者400例，完全随机分为2组，各200例。异丙酚组单纯用异丙酚静脉注射，联合组先用芬太尼后静脉注射异丙酚。术中记录不同时段的血氧饱和度、收缩压、舒张压、心率等参数值，并进行麻醉效果评定。结果异丙酚组优134例（67．0％），良66例（33．0％）；联合组优194例（97．0％），良6例（3．0％），联合组麻醉效果优于异丙酚组，差异有统计学意义（P〈0．05）。联合组麻醉后血氧饱和度值在30s后开始下降（P〈0．05），30—50s内下降极为明显，个别患者血氧饱和度降至70％以下，甚至发生呼吸暂停，60s趋于正常（P〉0．05）。结论麻醉后低氧血症最易发生在麻醉后30—50s，临床上应及时处理呼吸抑制状况，提高血氧饱和度值；正常剂量的异丙酚与阿片类药物并用，是可能导致患者的严重低氧血症的，需要围麻醉期间的密切监护，血氧饱和度明显下降的患者，需立即经面罩给氧，人工辅助呼吸，以确保安全。

Observation on the effects of propofol and fentanyl on patients' SpO2 in the painless operation of induced abortion

Objective To investigate the effects of propofol and fentanyl on oxygen saturation of patients in painless artificial abortion and find out that of combination therapy on the respiratory system. Methods Four hundred cases of patients were enrolled and were completely randomly divided into two groups with 200 cases in each group. A simple propofol was intravenously injected in the propofol group and the propofol was injected after the first intravenous injection of fentanyl in the combined group. The oxygen saturation systolic blood pressure, diastolic blood pressure, heart rate and other parameter values was recorded and anesthetic effect was evaluated. Results In the propofol group, excellent results showed in 134 cases (67.0%), good in 66 cases (33.0%). In the combined group, 194 cases was excellent (97.0%), good in 6 cases (3.0%), the combined group was superior to the propofol group, There were significant differences (P <0. 05). The oxygen saturation started to decline in the 30 s after anaesthetized in the combined group (P < 0. 05), a very obvious decline in 30 - 50 s, oxygen saturation declined to 70% or less in individual patients, or even apnea, tended to the normal in 60s (P 0. 05). Conclusion The most vulnerable time of hypoxemia after anesthesia occurred in the 30～50 s, clinical respiratory depression should be dealt with in time, improve the oxygen saturation value; the combined application of normal doses of propofol and opioids was likely to lead to patients severe hypoxemia, and still need close attention and prepare the appropriate rescue equipment during anesthesia. Patients decreasing significantly in oxygen saturation should immediately be provided oxygen by the mask and artificial assisted respiration.