人工流产术3种静脉麻醉方法比较

Comparison of Three Anesthesia Methods in Induced Abortion

目的:探讨门诊无痛人工流产术的最佳药物配伍及给药模式。方法:选取门诊就诊的早孕妇女237例,分为3组,Ⅰ组:瑞芬太尼4.0ng/ml,异丙酚3.5μg/ml靶控静脉泵输注;Ⅱ组:瑞芬太尼1.0μg/kg,异丙酚1.2mg/kg人工静脉推注;Ⅲ组:芬太尼0.8μg/kg术前5分钟给入,异丙酚2.0mg/kg人工静脉推注。监测血压、平均动脉压、心率、血氧饱和度。术毕观察腹痛、恶心、呕吐、嗜睡、眩晕等情况。结果:Ⅱ组用药量明显少于Ⅰ组,镇痛效果及对手术的影响两组近似,Ⅱ组呼吸抑制发生率低及苏醒时间短、定向力恢复快方面明显优于Ⅰ组。Ⅱ组与Ⅲ组在安全性、镇痛效果、副反应的发生率及对手术的影响方面均无差异,但用药量少、苏醒时间短,Ⅱ组有明显的优势。结论:在早孕无痛人工流产术中异丙酚辅以瑞芬太尼手推静脉给药,镇痛效果、安全性好,苏醒时间短,适于门诊无痛手术。

Objective：To explore the best choice of drug administration of different bolus doses and approach of remifentanil associated with propofol in the course of analgesia induced abortion. Methods：237 healthy females with first-trimester pregnancy were randomized to divide into 3 groups by different drug approach and dosage. Group Ⅰ （ n = 48） ： remifentanil （4.0 ng/ml） and propofol（3.5 μg/ml） were administrated by TCI. Group Ⅱ （ n = 83） ： remifentanil （1.0 μg/kg） and propofol （1.2 mg/kg） were administrated by intravenous bolus infusion（IBI）. GroupⅢ （ n = 106）： fentanil （0.8 μg/kg） were administrated 5 minutes pre-oparation and propofol （2.0 mg/kg） ware administrated by IBI. BP, HR, and SpO2 were recorded every one minute during surgery. After operation, abdominal pain, vomiting, nausea,narcoma, and dizziness were determined. Results： The analgesia effectiveness and influence on surgery ware similar between group Ⅱ with group Ⅰ （P〉0.05） ,but the dosage needed in group Ⅱ was lower than group Ⅰ .And the lower prevalence of respiratory depression, the shorten recovery time, and rapidly orientation force in group Ⅱ （ P 〈 0.01 ）. There were no differences in security, antalgic effective, and side effects between group Ⅱ and group Ⅲ （ P 〉 0.05）, but the less dosage and shorten recovery time ware common in group Ⅱ （ P 〈 0.01 ）. Conclusions：The effect of manual controlled infusion of propofol combined with remifentanil is definitely with analgesia effect, security and recovery time, and it is highly recommended for outpatients of induced abortion.