瑞芬太尼联合异丙酚在30例无痛人工流产手术中的临床应用

Remifentanil and Protocol in painless artificial abortion in the clinical application

目的:观察瑞芬太尼联合异丙酚用于无痛人工流产手术的可行性和安全性,并与异丙酚无痛人工流产术比较。方法:选择门诊ASAⅠ级早期妊娠需人工流产者60例,随机分成两组,异丙酚组(P组,n=30)和瑞芬太尼+异丙酚组(RP组,n=30)。P组:单纯静脉滴注异丙酚2.5 mg/kg。RP组:静脉滴注异丙酚1 mg/kg,瑞芬太尼1μg/kg,瑞芬太尼再以0.2μg/(kg.min)持续输注至负压吸引结束停药。记录注药开始至意识恢复时间、总用药量,并分别记录术前、术中、术毕患者的血压(SBP)、心率(HR)、脉搏血氧饱和度(SPO2)、呼吸频率(RR)和潮气量(VT)。结果:RP组BP和HR麻醉前、诱导后和术毕无显著性差异(P>0.05),P组诱导后比麻醉前BP显著降低(P<0.05),HR显著升高(P<0.05)。术毕RP组患者VT和RR已恢复至术前水平(P>0.05),P组手术的中后期和术毕,VT仍低于基础值(P<0.05),而RR较基础值显著加快(P<0.05)。术毕RP组苏醒时间(7.3±1.7)分钟,P组苏醒时间(9.9±1.5)分钟,有显著性差异(P﹤0.05)。异丙酚总用药量RP组(65.3±17.5)毫克,P组(160.7±23.8)毫克,有显著性差异(P﹤0.05)。结论:瑞芬太尼联合异丙酚在无痛人工流产手术中麻醉效果更佳,术中循环平稳,术后麻醉恢复迅速,可显著减少异丙酚用量,可以安全地用于妇科门诊人工流产手术。

Objective：To observe the feasibility and safety of remifentanil combined with Propofol during anesthesia in painless artificial abortion,and compared with simple Propofol induced abortion.Methods：A total of 60 ASA I women requiring voluntarily painless artificial abortion were randomized into two equal groups.One group was simple given Propofol 2.5 mg/kg（group P）,and the other given Propofol 1mg/kg,then Remifentanil 1ug/kg,then Remifentanil to 0.2μg/（kg·min） continuous infusion to the suction end of the withdrawal（group RP）,to record injection time to the consciousness recovery time、the total dosage、And recorded blood pressure（SBP）、 heart rate（HR）、 pulse oxygen saturation（SPO2）、 respiratory rate（RR） and tidal volume（VT） before、 during and end of surgery in patients.Results： No significant difference was noted in the induction time and after completion of surgery in group RP（P〉0.05）,but BP was significantly lower（P〈0.05）,HR increased significantly（P〈0.05） after induction than before anesthesia in group P.Group RP has been restored to the preoperative level（P〉 0.05） of surgery in patients with VT and RR,VT is still lower than baseline（P〈0.05） in the late surgery and the end of surgery in group P,while the RR was significantly accelerated compared with baseline（P〈0.05）.group RP（7.3±1.7） minutes was earlier than group P（9.9±1.5） minutes in the recovery time of surgery（P〈0.05）.There was significant difference in the total dosage of Propofol（P〈0.05）,and group RP（65.3±17.5） mg was less than group P（160.7±23.8） mg.Conclusions： Remifentanil was combined with Propofol in painless artificial abortion,and it provide better surgical anesthesia,intraoperative cyclostationarity,the rapid recovery after anesthesia,and reduced the dose of Propofol,so it can be safely used in gynecology outpatient abortion.