脑电双频指数监测异丙酚靶控输注无痛人工流产术的临床观察

目的 探讨脑电双频指数（BIS）监测异丙酚靶控输注无痛人工流产术的麻醉效果和麻醉安全.方法 将90例在异丙酚靶控输注下行人工流产术的早期妊娠妇女随机分为三组,各30例.开放静脉后注射盐酸瑞芬太尼0.05 mg,于60 s内静脉靶控注射1%丙泊酚,使BIS值分别达到65～84（Ⅰ组）、40～＜65（Ⅱ组）、30～＜40（Ⅲ组）,达标即开始手术.术中如出现肢动反应追加异丙酚首剂量的半量.术中常规监测血压、心率、心电图、脉搏血氧饱和度、BIS等,记录手术、诱导、苏醒、离室时间,以及手术过程中各组患者出现肢动反应、呼吸抑制、心动过缓、低血压的例数.结果 Ⅱ、Ⅲ组麻醉效果达优率分别为93.3%（28/30）、96.7%（29/30）,与Ⅰ组[50.0%（15/30）]比较,差异有统计学意义（P＜0.05）,Ⅱ、Ⅲ组患者麻醉效果比较,差异无统计学意义（P＞0.05）;三组诱导、苏醒、离室、手术时间比较,差异均无统计学意义（P＞0.05）;Ⅰ组体动反应发生率达90.0%（27/30）,与Ⅱ、Ⅲ组比较,差异有统计学意义（P＜0.05）;Ⅲ组心动过缓发生率（53.3%,16/30）、低血压发生率（56.7%,17/30）、呼吸抑制发生率（63.3%,19/30）与Ⅰ、Ⅱ组比较,差异均有统计学意义（P＜0.05）.结论 BIS监测异丙酚靶控输注无痛人工流产术,BIS值控制在40~〈65麻醉效果良好,麻醉安全有保障.

Clinical observation of propofol given by target-controlled infusion for painless artificial abortion under monitoring of BIS

Objective To explore the anesthetic effect and anesthesia safety of propofol given by target-controlled infusion for painless artificial abortion under the monitoring of bispectral index （BIS）. Methods A total of 90 early pregnant women, who were with painless artificial abortion under the target-controlled infusion of propofol,were divided into three groups with 30 cases in each group. The groups were with open intravenous injection of 0.05 mg remifentanil hydrochloride, and then with target- controlled infusion of 1% propofol in 60 seconds to make the BIS value reach to 65-84（group I ） ,40-〈65（group II ） and 30-〈40 （group III ）, and the operation was conducted when reaching standard. Half of first dosage of propofol was added when limb movement reaction was appeared during operation. Routine monitoring was conducted during operation on blood pressure （BP）,heart rate （HR）, electrocardiograph （ECG）, Pulse blood oxygen saturation （SpO2） and BIS, and to record operation time, induction time, recovery time, time of discharge and cases with limb movement reaction, respiratory depression, bradycardia or hypotension in all groups. Results The excellent rate of anesthetic effect in group II and group m was 93.3%（28/30） and 96.7%（29/30） respec tively, and compared with the group I [50.0% （15/30）], the difference had statistical significance （P〈0.05）. The difference between group II and group III on anesthetic effect had no statistical （P〉0.05）. The difference on induction time, recovery time, time of discharge and operation time in three groups had no statistical significance（P〉0.05 ）. The occurrence rate limb movement reaction in group I reached to 90.0% （27/30）, and compared with group II and group III,the difference had statistical significance （P〈0.05）. The occurrence rate of bradycardia, hypotension and respiratory depression in group m was 53.3% （16/30）, 56.7% （17/ 30） and 63.3% （19/30） respectively, and compared with group I and group II ,the difference had statistical significance （P〈0.05）. Conclusion The anesthetic effect is good with security when the BIS value is 40-〈65 with target-controlled infusion of propofol for painless artificial abortion under the monitoring of BIS.