异丙酚复合麻醉用于无痛人工流产的临床观察

The clinical observation of the combination effects of propofol,fentanyl,remifentanil and ketamine in painless artificial abortion

目的观察异丙酚复合芬太尼、瑞芬太尼、氯胺酮在无痛人工流产术中的作用。方法将120例早期妊娠要求行无痛人工流产的孕妇随机分为4组,I组:静脉注射芬太尼0.4μg/kg,60s内完成,然后注射异丙酚2mg/kg。II组:静脉注射瑞芬太尼0.2μg/kg,60s内完成,再注射异丙酚2mg/kg。III组:静脉注射氯胺酮0.4mg/kg,再注射异丙酚2mg/kg。IV组:静脉注射芬太尼0.2μg/kg后,静脉注射氯胺酮0.2mg/kg,再注射异丙酚2mg/kg。各组注射异丙酚在90s内完成。观察四组麻醉效果、人工流产综合征发生情况、苏醒时间、定向力恢复时间、出血量和不良反应等。结果II组的镇痛效果、苏醒时间、定向力恢复时间、离院时间比其他三组好,差异具有统计学意义(P<0.05),副作用的发生比其他三组少,差异具有统计学意义(P<0.05),无一例发生人工流产综合征。结论异丙酚复合小剂量瑞芬太尼用于无痛人工流产术在镇痛效果、苏醒时间、不良反应上较其他组有一定的优势,是目前较好的无痛人工流产方法之一。

Objective To observe and compare the combination efficacy and safety of propofol, fentanyl, remifentanil and ketamine in painless artificial abortion. Methods 120 early pregnancy patients scheduled for painless artificial abortion were randomly divided into four groups, Group Ⅰ was given propofol 2 mg/kg by intravenous injection, plus fentanyl 0. 4μg/kg with the injection finished in 60 seconds. Group Ⅱ was given propofol 2 mg/kg plus remifentanil 0. 2μg/kg with the injection finished in 60 seconds while Group Ⅲ propofol 2 mg/kg plus ketamine 0. 4 mg/kg and Group Ⅳ fentanyl 0. 2μg/kg plus ketamine 0. 2 mg/kg and propofol 2 mg/kg. All the injection of propofol finished within 90 seconds. The pain-relieving effect, artificial abortion syndrome, awake time, orientation recovery time, leaving time, blood loss and side effects et al of the four groups were observed. Results In group Ⅱ , the pain-relieving effect, awake time, orientation recovery time and leaving time were better than other groups（ P 〈 0. 05 ） , and the side effects were lower （P 〈 0. 05 ）. No induced abortion syndrome occurred in all groups. Conclusions Intravenous anesthetics with propofol and remifentanil can well relieve pain, reduce awake time and side effects, it is one of the best anesthetics in artificial abortion.