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目的比较丙泊酚复合瑞芬太尼靶控输注与单纯丙泊酚靶控输注用于无痛人工流产(人流)术的效果,探讨合理的静脉麻醉方法。方法80例美国麻醉医师协会(ASA)Ⅰ级接受无痛人流术的病人,分为两组,单纯丙泊酚靶控输注(TCI)组(P组)和丙泊酚复合瑞芬太尼TCI组(PR组),每组40例。P组:丙泊酚血浆靶浓度为6～7mg/L;PR组:丙泊酚血浆靶浓度为3.5～4mg/L、瑞芬太尼血浆靶浓度为1.8～2μg/L。待病人意识消失(睫毛反射消失、呼之不应)后开始手术,扩张宫颈结束时停止给药。结果①麻醉效果PR组优于P组(P<0.05)。②PR组诱导时间(1.1±0.4)min,明显短于P组(P<0.05),PR组丙泊酚总剂量(1.8±0.4)mg/kg,明显少于P组(P<0.01)。③苏醒期躁动、兴奋多语P组发生率分别为55%、50%,PR组未发生(P<0.01)。④两组麻醉后血压均明显下降(P<0.01),扩宫时最低,停药后很快回升,负压吸引时恢复至麻醉前水平(P>0.05),各时段脑电双频指数(BIS)值明显下降(P<0.01,P<0.05),负压吸引时最低,以后逐渐回升。结论在无痛人流术中,丙泊酚复合瑞芬太尼靶控输注优于单纯丙泊酚靶控输注,麻醉效果好、诱导时间短、显著减少丙泊酚用量、减少不良反应,是一种安全、合理的静脉麻醉方法。
Objective To compare the effects of target-controlled infusion of propofol and remifentanil with target-controlled infusion of propofol for painless abortion (abortion) and to explore a reasonable method of intravenous anesthesia. Methods Eighty ASA Ⅰ patients undergoing painless abortion were randomly divided into two groups: propofol TCI group (group P) and propofol combined remifentanil group TCI group (PR group), 40 cases in each group. P group: Propofol plasma target concentration of 6 ~ 7mg / L; PR group: propofol plasma target concentration of 3.5 ~ 4mg / L, remifentanil plasma target concentration of 1.8 ~ 2μg / L. When the patient disappeared consciousness (eyelash reflex disappeared, call should not) after surgery, dilatation of cervical termination of administration. Results ① The anesthetic effect was better in PR group than in P group (P <0.05). ② The induction time of PR group (1.1 ± 0.4) min was significantly shorter than that of P group (P <0.05). The total dose of propofol in PR group was (1.8 ± 0.4) mg / kg less than that of P group (P <0.01). (3) The onset of restlessness and excitement in multilingual P group were 55% and 50% respectively, but not in PR group (P <0.01). (4) After anesthesia, the blood pressure of the two groups were significantly decreased (P <0.01), the lowest was when dilated, and recovered quickly after withdrawal, and recovered to the level before anesthesia during negative pressure (P> 0.05) BIS) decreased significantly (P <0.01, P <0.05), the lowest when it was negative pressure, and then gradually recovered. Conclusion In painless abortion, the target controlled infusion of propofol and remifentanil is better than the target controlled infusion of propofol. The anesthetic effect is good, the induction time is short, the dosage of propofol is significantly reduced, the adverse reaction is reduced, Is a safe and reasonable method of intravenous anesthesia.