人工流产术中不同镇痛药物复合靶控输注异丙酚麻醉的效果——多中心研究

Different opioids combined with target-controlled infusion of propofol for artificial abortion： a multicenter study

目的比较人工流产术患者瑞芬太尼、芬太尼及舒芬太尼复合靶控输注异丙酚麻醉的安全性和有效性。方法采用前瞻性、多中心、开放、随机分组、对照研究的方法。4个研究中心共选择390例行人工流产手术患者,随机分为3组：芬太尼单次静脉注射组（F组,n=134）、瑞芬太尼血浆靶控输注组（R组,n=120）和舒芬太尼单次静脉注射组（S组,n=136）,分别复合异丙酚血浆靶控输注行全身麻醉,记录起效时间、恢复时间、准确定向时间、术中体动（程度和次数）、镇痛效果、呼吸抑制评分和HR、MAP、SpO2及术后并发症的发生情况等。结果3组间麻醉起效时间和准确定向力时间差异无统计学意义（P＞0．05）,R组麻醉恢复时间长于F组和S组（P＜0．01）,R组异丙酚总用量、术中最低SpO2、术中体动次数及术后恶心呕吐、嗜睡的例数均低于F组和S组（P＜0．05或0．01）,R组呼吸抑制评分高于F组和S组（P＜0．01）。结论与芬太尼和舒芬太尼相比,瑞芬太尼复合异丙酚靶控输注麻醉用于人工流产手术镇痛效果更好,但其呼吸抑制作用较明显。

Objective To evaluate the comparative efficacy and safety of remifentanil, fentanyl and sufentanil combined with propofol given by target-controlled infusion （TCI） for artificial abortion. Methods Three hundred and ninety ASA Ⅰ patients aged 18-40 yr undergoing artificial abortion were randomly divided into 3 groups： group Ⅰ received a single bolus of fentanyl 1μg/kg （F, n = 134） ; group Ⅱ received remifentanil given by TCI （target plasma concentration CT = 4 ng/ml） （R, n = 120） and group Ⅲ received a single bolus of sufentanil 0.1 μg/kg （S, n = 136）. All patients in the 3 groups were anesthetized with TCI of propofol （CT = 4 μg/ml ）. The onset time （from start of TCI of propofol to loss of eye-lash reflex）, the recovery time （from the end of operation to eye-opening on verbal command）, orientation time （from eye-opening on verbal command to correctly telling one＇s birthday）, body movement during operation, respiratory depression score （1 = normal respiratory rate, 2 = RR 8-12 bpm, 3 = RR 〈 8 bpm）, HR, MAP, SpO2 during operation, side-effects after operation and the total amount of propofol used were recorded and compared among the 3 groups. Results There was no significant difference in onset time and orientation time among the 3 groups. The recovery time was significantly longer in group R than in group F and S （P 〈 0.01）. The total amount of propofol was smaller and the incidence of body movement during operation and postoperative nausea and vomiting and somnolence were significantly lower in group R than in group F and S （P 〈 0.01, 0.05）. Respiratory depression was severer in group R than in group F and S （ P 〈 0.01 ）. Conclusion The analgesic effect of propofol by TCI plus remifentanil via TCI is best with less sideeffect among the 3 groups but more attention should be paid to respiratory depression in group R.