瑞芬太尼依托咪酯利多卡因三种药物分别复合丙泊酚用于门诊无痛人流术中麻醉效果比较

Comparison of Anesthetic Effects of Remifentanil Etomidate or Lidocaine Combined with Propofol for Painless Induced Abortion in Outpatients

目的:探究瑞芬太尼、依托咪酯、利多卡因三种药物分别复合丙泊酚用于门诊无痛人流术中麻醉效果的区别。方法:将我院门诊2017年1月至2018年3月收治的108例无痛人流患者,按电脑随机序号法分为三组,分别为瑞芬太尼复合丙泊酚麻醉的Ⅰ组(n=36),依托咪酯复合丙泊酚麻醉的Ⅱ组(n=36)和利多卡因复合丙泊酚麻醉的Ⅲ组(n=36),分别检测和比较患者术中血流动力学变化、镇痛效果、麻醉效果、术后恢复情况和不良反应。结果:MAP、HR组间、时间和交互差异均有统计学意义(P<0.05),而SpO2组间、时间、交互分析差异均无统计学意义(P>0.05);Ⅰ组、Ⅲ组患者T1、T2时间点MAP、HR较T0降低(P<0.05),Ⅱ组患者T1、T2时间点MAP、HR较Ⅰ组高,Ⅲ组患者T1、T2时间点MAP、HR较Ⅱ组低(P<0.05);三组Ramsay评分和麻醉效果均无明显差异(P>0.05),Ⅱ组VAS评分明显低于其他两组(P<0.05),Ⅰ组和Ⅲ组VAS评分无明显差异(P>0.05);Ⅱ组睁眼、自主呼吸和恢复行走时间明显长于其他两组(P<0.05),Ⅰ组和Ⅲ组差异不具有统计学意义(P>0.05);三组均出现注射痛、恶心、嗜睡、头晕和术后疼痛的不良反应,但其差异不具有统计学意义(P>0.05)。结论:三组都具有良好的麻醉效果,相较于其他两组依托咪酯复合丙泊酚麻醉效果更好,手术中血流波动幅度更小,术后疼痛程度更轻,但术后意识恢复时间略长。

Objective: To explore the differences of anesthetic effects of remifentanil,etomidate or lidocaine combined with propofol for painless induced abortion in outpatients. Methods: 108 cases of patients with painless induced abortion admitted to our hospital from January 2017 to March 2018 were divided into three groups according to thecomputer random number method,including group I (remifentanil combined with propofol anesthesia,n=36),group Ⅱ(etomidate combined with propofolanesthesia,n=36) and group Ⅲ(lidocaine combined with propofol,n=36). The intraoperative hemodynamic changes,analgesic effects,anesthetic effects,postoperative recovery and adverse reactions were detected and compared. Results: There were significant differences in the betweee-groups effects,time effects and interaction effects of MAP and HR (P<0.05),but there were no significant differences in the betweee-groups effects,time effects and interaction effects of SpO 2 (P>0.05).,The MAP and HR in groups I and Ⅲ at T1 and T2 were lower than those at T0 (P<0.05),and the MAP and HR in group Ⅱ at T1 and T2 were higher than those in group I,and the MAP and HR in group Ⅲ at T1 and T2 were lower than those in group Ⅱ(P<0.05). There were no significant differences among the three groups in Ramsay score and anesthetic effects (P>0.05),and the VAS score in group Ⅱ was significantly lower than that in the other two groups (P<0.05),and there was no significant difference in VAS score between group I and group Ⅲ(P>0.05). The blinking time,spontaneous breathing and recovery walking time in group Ⅱ were significantly longer than those in the other two groups (P<0.05),and there was no significant difference between group I and group Ⅲ(P> 0.05). Adverse reactions of injection pain,nausea,lethargy,dizziness and postoperative pain were observed in all three groups,but the difference was not statistically significant (P>0.05). Conclusion: All the three groups have good anesthetic effects. Compared with the other two groups,etomidate combined with propofol anesthesia has better anesthetic effects,smaller blood flow fluctuation during operation and lighter postoperative pain degree,but slightly longer postoperative consciousness recovery time.