摘要
目的：探讨靶控输注丙泊酚复合瑞芬太尼、地佐辛用于无痛人工流产术的有效性和安全性。方法选择60例美国麻醉医师协会（ ASA）分级Ⅰ～Ⅱ级行无痛人工流产术的患者，将患者完全随机分为2组，靶控输注丙泊酚组（ TCI组）和手控输注丙泊酚组（ MCI组），每组30例。 TCI组设定丙泊酚初始血浆靶浓度为6 mg/L，术中根据手术进程滴定目标靶浓度；MCI组以丙泊酚2 mg/kg诱导，术中发生体动反应时追加丙泊酚20～30 mg。2组均在术前5 min静脉滴注地佐辛5 mg，入睡后即刻小壶滴注瑞芬太尼1μg/kg。观察并记录2组丙泊酚的总用量、麻醉效能、术中呼吸循环的变化及术后不良反应等指标。结果 TCI组丙泊酚的总用量为（2．55±0．34）mg/kg，明显大于MCI组的（2．10±0．20）mg/kg（P＜0．01）；TCI组麻醉效果优的比例高于MCI组[83．3％（25/30）比53．3％（16/30），P＜0．05]、术中体动反应的发生率低于MCI组[16．7％（5/30）比46．7％（14/30），P ＜0．05]；除诱导时间 TCI 组[（1．27±0．15） min]长于 MCI 组[（1．09±0．15）min]外，2组患者的手术时间、意识恢复时间、清醒时间差异均无统计学意义；麻醉诱导后，2组患者的平均动脉压、心率均下降（均P＜0．01），但2组间差异无统计学意义（P＞0．05），术毕时平均动脉压均回升至术前水平；2组患者均无明显的术后宫缩痛。结论丙泊酚靶控输注复合瑞芬太尼、地佐辛用于无痛人工流产术麻醉效果安全舒适，麻醉深度易于控制，但术中须注意对患者呼吸功能的支持。
Objective To evaluate the efficacy and safety of propofol by target-controlled infusion （TCI） combined with remifentanil and dezocine for artificial abortion .Methods According to the different anesthesia , sixty patients were randomly divided into two groups in chronological order （ n=30 each ）：group TCI and group manual-controlled infusion （group MCI）.The initial target plasma concentration of group TCI was 6 mg/L, titra-ting the goal target concentration during the surgical process .The induction dose of propofol was 2 mg/kg in group MCI, supplying propofol by 20-30 mg.5 mg dezocine was infused 5 minutes before anesthesia and 1 μg/kg remifentanil was infused immediately after sleeping for each group .The anesthetic effect , change of respiration and circulation , total dose of propofol and side-effect of operation were observed and recorded .Results Total dose of propofol used in group TCI was （2.55 ±0.34） mg/kg,which was significantly more than that of group MCI [（2.10 ±0.20）mg/kg] （P〈0.01）.Compared with group MCI, the ratio of excellent anesthesia in group TCI was higher [83.3%（25/30） vs 53.3%（16/30）, P〈0.05], and the incidence of body movement was less in group TCI [16.7%（5/30） vs 46.7%（14/30）, P〈0.05].The induced time in group TCI was （1.27 ± 0.15）min, which was longer than that of group MCI [（1.09 ±0.15） min, P〈0.01], but there was no signifi-cant difference in the recovery time between the two groups .The mean arterial pressure （ MAP） and heart rate （HR） were lower after induction （P〈0.01）, but the MAP returned to normal at the end of surgery in both groups.The changes of MAP and HR in group TCI and group MCI were not significantly different （P〉0.05）.No severe postoperative pain from uterine contraction occurred in all the patients .Conclusions Target-controlled in-fusion of propofol combined with remifentanil and dezocine for artificial abortion is safe and effective with good con -trollability, but respiratory support sh
出处
《中国医药》
2014年第9期1350-1354,共5页
China Medicine
关键词
人工流产
丙泊酚
靶控输注
瑞芬太尼
地佐辛
Artificial abortion
Propofol
Target-controlled infusion
Remifentanil
Dezocine
