异丙酚复合瑞捷用于人工流产术的临床研究

Clinical Application of Propofol plus Remifentanil to Artificial Abortion

目的用4种不同配方的全麻药物行人工流产术,对其临床效果进行比较,为更加安全、有效的麻醉方法提供选择。方法80例 ASAI 级18～37岁早孕妇女,分为4组,每组20例,Ⅰ组：单纯异丙酚静注；Ⅱ组：异丙酚3mg/kg+瑞捷50μg 混合液静注；Ⅲ组：异丙酚2mg/kg+瑞捷100μg 混合液静注；Ⅳ组：异丙酚1mg/kg+瑞捷150μg 混合液静注。病人入室后开放静脉,监测 BP、HR 和 SpO_2,取上述分组中的一组药物静注,待病人睫毛反射消失开始手术,术中出现体动追加药物,手术操作过半停止用药。术中常规吸氧和辅助呼吸,术毕送入麻醉恢复室,清醒后无不适,自行离院。结果所有病人术中无记忆,BP 变化不大,呼吸均有不同程度的抑制,HR＜56bpm 使用阿托品0．5mg 静脉推注有2例,分别为Ⅲ、Ⅳ组各1例,Ⅰ组异丙酚用量最多,体动率最高,Ⅳ组效果最好、体动率最小、清醒最快、离院时间最短,但呼吸暂停率为100%。结论人工流产不宜单纯使用镇静药,而应同时应用镇痛药才能达到无痛人流的目的。4组配方比较Ⅳ组疗效最好,但术中必须常规 SpO_2监测、面罩吸氧和辅助呼吸。凡全麻下人流均应备用急救药品和设备,以策安全。

Objectives To provide a safer and more effective anesthesia for artificial abortion.. Methods Eighty women with early pregnancy（ASA Ⅰ,aged 18 - 37 years old, ）were divided into four groups of 20 persons each, The pregnant women in groups Ⅰ , Ⅱ , Ⅲ and Ⅳ were anaesthetized respectively by the intravenous injection of propofol only, 3mg/kg propofol plus 50μg mmifentanil, 2mg/kg propofol plus 100μg remifentanil, and 1mg/kg pmpofol plus 150μg remifentanil when undergoing artificial abortion. The blood pressure（BP）, heart rate （HR）and SpO2 in the pregnant women were monitored during the operation. The surgery started after the patients lost their eyelash reflex, and more anesthetics were added if the limbs movement was observed during the surgery. The administration of anesthetics stopped in the last half of the surgery. Oxygen and artificial ventilation were given to all the patients during the surgery. Results During the surgery, all the patients had no memory, little changes in BP, and different respiratory inhibition in degree. Four patients （2 in each of both the groups Ⅲ and Ⅳ ） were given intravenous injeclion of 0.5mg atropine when their Ⅰ-Ⅲ was fewer than 56 BPM. The patients in group Ⅰ were given the largest dose of proofol, and had highest rate of limbs movement. The anaesthetic effect in group Ⅳ was the best in the four groups because the patients in group Ⅳ had lowest rate of limbs movement during the surgery, woke up quickly after the surgery, and were discharged from hospital in the shortest time period after the surgery. However, all the patients in group Ⅳ had apnea during the surgery. Conclusions Analgesics need to be used in combination with sedative for a painless artificial abortion.The anaesthetic effece of 2mg/kg pmpofol plus 100μg remifentanil on the artificial abortion is very good and however, SpO2 monitoring, oxygenation with mask and artificial ventilation should be routinely performed during the surgery. Drugs and equipments for first aid need to be prepared during all the artificial abortions under general anesthesia.