靶控输注异丙酚配伍不同的麻醉性镇痛药用于人工流产术的比较

The comparison of target-controlled propofol infusion combined with different narcotic analgesics during induced abortion

目的比较靶控输注异丙酚与不同的麻醉性镇痛药配伍用于人工流产术的可行性和优越性。方法选择120例进行无痛人工流产手术的病人，ASAⅠ-Ⅱ级，随机分为靶控输注异丙酚和瑞芬太尼组（R组），异丙酚和舒芬太尼组（S组），异丙酚和芬太尼组（F组）。设定异丙酚血浆靶浓度为4μg／ml，病人入睡后R组静脉推注瑞芬太尼0．2ng／kg，F组和S组分别静脉推注芬太尼1μg／kg和舒芬太尼0．1μg／kg。术中遇体动时酌情追加异丙酚。观察术中呼吸抑制情况和血流动力学变化，记录术毕患者呼之睁眼时间、听从指令时间和定向力恢复时间，评价麻醉效果。结果R组麻醉效果满意度最高，异丙酚用药量最少，为132．05±25．46mg。术毕清醒时异丙酚血浆浓度为2．01±0．47μg／ml，明显高于其他两组（P〈0．05）。R组术毕各个清醒时间均短于S组和F组，有极显著差异（P〈0．01）。术中血流动力学变化，R组和S组一定程度地降低MBP，对HR影响不大。同时R组呼吸抑制的情况明显比F组和S组严重，有统计学意义。结论三种方法的比较中，靶控输注异丙酚复合瑞芬太尼麻醉效果最佳，节省麻醉药用量．菰醒讯_i柬．伯孽滓责苴对呼吸的抑制作用．

Objective To compare the feasibility and the advantage of target-controlled propofol infusion combined with three different narcotic analgesics during induced abortion. Methods 120 ASA Ⅰ-Ⅱ patients undergoing induced abortion were randomly allocated into three groups： propofol was set at 4μg/ml as target plasma concentration in all groups and remifentanil 0.2ng/kg, fentanil 1 μg/kg and sufentanil 0.1 μg/kg was infused respectively in group R, F and S. MBP, HR and SpO2 were monitored and recorded. TCI of propofol was started from the beginning and then analgesics were in- fused when patients lost consciousness, the propofol infusion was stopped at the end of operation. Quality of anesthesia was evaluated and the total amount consumed of propofol was calculated. The recovery time and respiration situation were recorded. Results The anesthetic satisfactory cases in group R are more than that in others （ P 〈 0.05 ）. The total consumption of propofol （132.05 ± 25.46mg） is the least in group R and the difference is significant（P 〈 0.05 ） . The recovery time is significantly shorter （P 〈0. 01 ） in group R （2.01 ± 1.62min） than that in group F （2.56 ± 1.93min） and in group S （2.54 ±1.88min）. The respiration inhibition was serious in group R. Conclusion Anesthesia with propofol by TCI combined with remifentanil is more group R the time needed to recovery is shorter and rious and oxygen or assistant respiration is needed effective during induced abortion compare to other two analgesics, in the consumption of propofol is fewer. But respiration inhibition is seduring anesthesia.