瑞芬太尼联合异丙酚在无痛人流术中的临床应用

Clinical Application about Remifentanil Combined with Propofol in Painless Abortion

目的观察瑞芬太尼联合异丙酚平衡麻醉不同给药方法对无痛人流患者呼吸循环的影响,探讨二者最佳给药方法和临床应用的可行性。方法随机选择无痛人流患者90例,随机分成3组。Ⅰ组采用异丙酚2mg/kg+芬太尼1μg/kg静脉注射负荷剂量后,异丙酚2～3mg/(kgh)持续静脉泵注;Ⅱ组采用异丙酚2mg/kg+芬太尼1μg/(kgh),瑞芬太尼0.05μg/(kgmin)持续静脉泵注;Ⅲ组采用异丙酚2mg/kg静脉注射负荷剂量后,异丙酚2～3mg/(kgh),瑞芬太尼0.1μg/(kgmin)持续静脉泵注。各组均于术毕即该停药。观察并记录各组患者停药后1、2、3、4、5min改良OAA/S评分、苏醒时间和苏醒期间的不良反应。结果 3组患者苏醒期躁动方面差异无统计学意义(P>0.05)。Ⅱ组、Ⅲ组患者苏醒时间明显短于Ⅰ组患者;Ⅰ组、Ⅱ组患者发生呼吸暂停例数明显多于Ⅲ组(P<0.05)。Ⅱ组、Ⅲ组停药后3、4、5minOAA/S评分明显高于Ⅰ组(P<0.05)。结论瑞芬太尼联合异丙酚在无痛人流术中应用,具有苏醒快、不良反应少等优点,但最好采用持续给药并加强呼吸监测。

Objective To observe the effect about remifentanil combined with propofol anesthesia balanced flow of different delivery methods on pain in patients with respiratory and circulatory, and to discuss the two best delivery methods and the feasibility of clinical application. Method Randomly selected 90 patients with painless induced abortion were randomly divided into 3 groups. I group were treated with propofol 2mg/kg ＋ fentanyl 1μg/kg after inlravenous loading dose, and propofol 2-3mg/（kg.h） continuous intravenous infusion; II group were treated with propofol 2mg/kg ＋ fentanyl 1μg/（kg.h）, and remifentartil 0.05μg/（kgomin） continuous intravenous infusion;III group were treated with intravenous propofol 2mg/kg loading dose, propofol 2-3mg/（kg·h）, and remifentanil 0.1μg/（kg·min） continuous intravenous infusion. Patients in each group were taken at the completion of the withdrawal. Observe and record the patients in each group after stopping 1, 2, 3, 4, 5min modified OAA/S score, wake time and wake up during the adverse reactions. Result 3 groups patients in recovery period no significant difference in agitation （P〉0.05）. Group II, III patients recovery time was significantly shorter in group I patients; I group, 11 apnea patients occurred significantly more than the number of cases in group III （P〈0.05）. Group II, III group after stopping 3, 4, 5 rain OAA/S score was significantly higher than that in group I （P〈0.05）. Conclusion Remifentanil combined with propofol in the application of painless abortion, has regained consciousness quickly, the advantages of fewer adverse reactions, it is best to use continuous monitoring of drug delivery and enhance breathing.