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目的:探讨瑞芬太尼在无痛人工流产术中应用的有效性和安全性。方法:选取准备行无痛人工流产术患者150例,随机分为盐水对照组(N组,n=30)、芬太尼组(F组,n=30)和瑞芬太尼组(R组,n=30)。N组采用0.9%氯化钠+异丙酚,F组采用芬太尼0.5μg/kg+异丙酚,R组采用瑞芬太尼0.5μg/kg+异丙酚,各组异丙酚剂量均为1.5~2.0 mg/kg;记录患者入室时(T1)、诱导后2 min(T2)、术毕时(T3)的生命体征(SBP、HR、SpO2),异丙酚总用量及苏醒时间,围术期恶心、呕吐发生率,麻醉效果优良率,苏醒后3 min时腹痛VAS评分及苏醒后幻觉发生率。结果:(1)F组、R组患者在T2时SBP降低,与T1时相比差异有显著性(P<0.05);T2时F组HR升高、R组HR降低,与T1时相比差异有显著性(P<0.05),3组患者SpO2组内、组间差异均无显著性(P>0.05)。(2)F组、R组麻醉效果优良率显著优于单独使用异丙酚的N组(P<0.05);(3)F组、R组苏醒时间均较N组延长(P<0.05),其中F组苏醒时间最长,但F组与R组苏醒时间之间比较差异无显著性(P>0.05);(4)F组、R组患者术后中重度腹痛发生率明显少于N组(P<0.05)。结论:瑞芬太尼复合异丙酚用于无痛人工流产术可以获得良好的麻醉效果,但瑞芬太尼组与芬太尼组各指标相比差异均无显著性,因此瑞芬太尼在小剂量时不能很好地体现出其短效、速效等优点。
Objective: To investigate the effectiveness and safety of remifentanil in painless artificial abortion. Methods: A total of 150 patients with painless abortion were enrolled and randomly divided into saline control group (N group, n = 30), fentanyl group (F group, n = 30) and remifentanil group (R group , n = 30). 0.9% sodium chloride + propofol was used in group N, fentanyl 0.5μg / kg + propofol in group F, and remifentanil 0.5μg / kg + propofol in group R. The dose of propofol in each group was 1.5 ~ 2.0 mg / kg. The vital signs (SBP, HR, SpO2), total propofol dosage and recovery time were recorded at T1, 2 min and T3 after operation Nausea and vomiting during operation, excellent rate of anesthetic effect, VAS score of abdominal pain 3 min after awakening and incidence of hallucination after waking. Results: (1) The SBP of group F and group R decreased at T2, which was significantly different from that at T1 (P <0.05). At T2, the HR of group F increased and that of group R decreased (P <0.05). There was no significant difference between the three groups in the SpO2 group (P> 0.05). (2) The excellent and good rates of anesthesia in group F and group R were significantly better than those in group N (P <0.05). (3) The recovery time of group F and group R was longer than that of group N (P <0.05) Among them, the recovery time of group F was the longest, but there was no significant difference between group F and group R (P> 0.05). (4) The incidence of postoperative moderate to severe abdominal pain in group F and group R was significantly less than that in group N (P <0.05). Conclusion: Remifentanil combined with propofol for painless artificial abortion can achieve good anesthetic effect, but there is no significant difference between remifentanil and fentanyl group, so remifentanil In small doses can not well reflect its short-acting, quick and so on.