丙泊酚复合不同剂量阿芬太尼用于无痛人流术的临床观察

The clinical observation of the different doses of alfentanil combined to propofol anesthesia for abortion

目的观察阿芬太尼联合丙泊酚用于无痛人流术的安全性与有效性。方法选择ASAⅠ或Ⅱ级拟在静脉全身麻醉下行无痛人流术患者90例,随机均分为三组:分别静注芬太尼1μg/kg(F1组)、阿芬太尼5μg/kg(F2组)、10μg/kg(F3组),泵注丙泊酚2.0 mg·kg^(-1)·min^(-1)直至改良清醒镇静(MOAA/S)评分为0分为止。记录注药前(T_1)、睫毛反射消失时(T_2)、手术开始时(T_3)、手术开始后1min(T_4)、术毕(T_5)及清醒时(T_6)的MAP、HR、SpO_2、SNAP指数(SI),各组丙泊酚的总用量、起效时间、手术时间、意识恢复时间、清醒时间,手术过程中体动反应,患者清醒后10、30 min的疼痛VAS评分,记录不良反应的发生率。结果 T_2时F1组S1明显低于F2、F3组,T_3时F2组MAP及SI均明显高于、HR明显快于F1、F3组(P<0.05),T_2、T_3时F3组的SpO_2明显低于F1组(P<0.05),但均在正常值范围。F3组丙泊酚总用量明显少于F1与F2组(P<0.05),F2、F3组起效时间、意识恢复时间、F3组的清醒时间均明显短于F1组(P<0.05),F2组发生体动反应的例数明显高于F1、F3组(P<0.05)。结论阿芬太尼10μg/kg与丙白酚联合用于无痛人流术是安全有效的。

Objective To observe the effectiveness and safety of alfentanil combined to propofol anesthesia for abortion. Methods Ninety ASA I or Ⅱ patients scheduled for elective abortion under total intravenous anesthesia were randomly assigned into three groups with 30 cases each. Group F1 received fentanyl 1μg/kg intravenously i. v, group F2 received alfentanil 5 /,g/kg i. v, and group F3 received alfentanil 10μg/kg i. v. Three groups were given 2.0 mg.kg-1 .min a of propofol until the responsiveness MOAA/S scale was zero. MAP, HR, SpO2 and SI were recorded before injection of test drug （T1）, loss of the eyelash reflex（Te ）, at the beginning of the operation （T3）, 1 min after the operation （T4）, at the end of the operation （T5） and awakening （T6）. The total usage of propofol, onset time, time duration of surgery, recovery time and awakening time along with side effects were determined, Postoperative abdominal pain intensity was assessed at 10 and 30 min with VAS scale. Results Compared with group F1, SI increased at Te in groups F2 and F3 （P〈 0. 05）. At Ta, MAP, HR and SI were higher in group F2 than those in groups F1 and F3 （P〈0. 05）. StK）e was lower in group F3 than that in group F1 at T2 and Ta （P〈0. 05）. The total dose of propofol was less in the group F3 compared with the other two groups （P〈0. 05）. The onset time of propofol and recovery time in the groups F2 and F3 and the time to awakening in group F3 were shorter than those in group F1 （P〈0. 05）. Patients moving in response to surgical stimulation in the group F2 were far more than those in groups F1 and F3 （P〈0. 05）. Conclusion 10μg/kg alfentanil combined to propofol is an effective and safe anesthesia for abortion.