摘要
目的基于复合靶控输注(TCI)瑞芬太尼的基础上,观察右美托咪啶用于无痛人流术的麻醉效果及安全性。方法 82例ASAⅠ~Ⅱ级清宫患者,随机分为DR组(观察组,42例)和PR组(对照组,40例)。DR组缓慢静脉注射(大于10min)右美托咪啶0.75μg/kg。PR组缓慢静脉推注丙泊酚1mg/kg。再分别对DR组及PR组输注血浆靶浓度(Cp)为2~2.5ng/ml的TCI瑞芬太尼输注,逐渐增加,直至满足手术要求,最大可至4ng/ml。记录术前(T1)、置入阴道窥器时(T2)、扩宫时(T3)、吸宫时(T4)和手术结束时(T5)的SBP、DBP、MAP、HR和SpO2。记录患者镇静评分、唤醒时间和定向力的恢复时间,并观察围术期患者呼吸抑制、术后宫缩痛情况。结果 DR组中T2、T3、T4时的HR较T1时显著降低,差异具有统计学意义(P<0.05);PR组中T2、T3、T4时的MAP、SpO2相比T1时显著下降(P<0.05)。DR组在T2、T3时的MAP、SpO2显著高于PR组,DR组在T2、T3、T4时的HR显著低于PR组(P<0.05)。此外,DR组的唤醒时间和定向力恢复时间相对PR组显著缩短(P<0.05)。同时,DR组的围术期呼吸抑制及术后宫缩痛(VAS)发生率明显低于PR组(P<0.05)。结论无痛人工流产手术中患者应用0.75μg/kg右美托咪啶复合TCI瑞芬太尼效果满意。
Objective To evaluate the safety and validity of dexmedetomidine combined with target-controlled infusion (TCI) with remifentanil in painless artificial abortion. Methods 82 patients who were undergoing painless artificial abortion were randomly divided into DR group(42 patients) and PR group(40 patients). The patients in DR group received dexmedetomi- dine (0.75~g/kg) and the PR group received propfol (lmg/kg). The target plasma concentration (Cp) of remifentanil was set at 2~2.5ng/ml and kept increasing until met the needs of operation. The max Cp of remifentanil was controlled within 4ng/ml. Sys- tolic pressure (SBP), diastolic pressure (DBP) and mean arterial pressure (MAP) of preoperative (T1), inserting vaginal speculum (T2), enlarging cervix (T3), pulling (T4) and the end of operation (Ts), and heat rate (HR), pulse oxygen saturation (SpO2). Ram- say,awake time, orientation recovery time were recorded, and the rates of patients" respiratory depression and postoperative u- terine contraction pain were observed. Results HR at T2,T3,T4 was significantly lower than that at T1 in DR group (P〈0.05). MAP and SpO2 at T2,T3,T4 were significantly lower than those at TI in PR group (P〈0.05). MAP and SpO2 at T2,T3 in DR group were significantly higher than those in PR group, HR at T2,T3,T4 in DR group were significantly lower than that in PR group(P〈 0.05). The awake time and orientation recovery time in DR group were significantly less than those in PR group (P〈0.05). The rates of patients' respiratory depression and postoperative uterine contraction pain in DR group were significantly less than those in PR group (P〈0.05). Conclusion The application of 0.75μg/kg dexmedetomidine combined TCI with remifentanil in pain- less artificial abortion is satisfactory.
出处
《中国现代医药杂志》
2013年第5期67-69,共3页
Modern Medicine Journal of China
关键词
右美托咪啶
瑞芬太尼
丙泊酚
靶控输注
无痛人工流产
Dexmedetomidine Remifentanil Propofol Target-controlled infusion Painless artificial abortion