异丙酚复合瑞芬太尼靶控输注用于无痛人工流产术的临床观察

Observation of Propofol Plus Remifentanyl Given by Target-controlled Infusion for Analgesic Artificial Abortion

目的:观察异丙酚复合瑞芬太尼靶控输注(TCI)用于无痛人工流产术的临床效果,探讨合理的静脉麻醉方法。方法:100例ASAⅠ级接受无痛人流术的病人随机分为两组,单纯异丙酚TCI组(P组)和异丙酚复合瑞芬太尼TCI组(PR组),每组50例。P组:异丙酚的血浆靶浓度为6 mg/L;PR组:异丙酚的血浆靶浓度为3 mg/L,瑞芬太尼血浆靶浓度为2μg/L。待病人意识消失(睫毛反射消失)后开始手术,扩张宫颈结束时停止给药。结果:PR组麻醉起效时间(1.8±0.8 min)明显短于P组(P<0.01);PR组麻醉效果的优良率明显优于P组(χ2=12.25,P<0.01);PR组异丙酚总用量(2.6±0.3 mg/kg)及呼吸抑制评分(2.1±0.8)明显小于P组(P<0.01)。P组苏醒期躁动和兴奋多语的发生率分别为34%及31%,PR组未发生,差异有统计学意义(P<0.01)。结论:异丙酚复合瑞芬太尼靶控输注用于无痛人流术,麻醉效果好,不良反应少,是一种合理的静脉麻醉方法,但应该加强麻醉期间的呼吸管理。

Objective： To observe the effects of target-controlled infusion（TCI） of propofol plus remifentanyl on analgesic artificial abortion. Methods： One hundred patients with ASA Ⅰ ,aged 18-45 undergoing analgesic artificial abortion were randomly divided into two groups （50 in each group） ：Group P and Group PR. The patients in group P were given propofol at a plasma concentration of 6 mg/L; the plasma concentration of propofol was set at 3 mg/L and remifentanyl at 2μg/L in group PR. The operations were started after the patients lost consciousness （no response to voice command and loss of eyelash reflex） and TCI stopped when dilating cervix uteri was over. Results：The onset time in group PR （1.8＋0.8 min） was shorter than that in group P （P〈0.01） ;The anesthetic effect in group PR was significantly better than that in group p（x^2 = 12.25, P〈0.01）.The total dosage of propofol （2.6＋0.3）mg/kg and score of respiratory depression （2.1＋0.8） were significantly lower than that in group P（P〈0. 01）.Group P had restlessness and hyperphasia during reanimation stage,accounting for 34% and 31% respectively, while group PR had nothing occurred （P〈0.01）. Conclusion：The TCI of propofol plus remifentanyl on analgesic artificial abortion showed a better anesthetic effect and a less adverse reaction. It is a reasonable vein anesthesia, but attention should be paid to its respiratory depression effect.