标题：不同剂量瑞芬太尼与丙泊酚联合应用于无痛人流效果观察

      作者：黎阳，区志荣，陈杨毅，高桂锋    东莞市企石医院麻醉科，广东 东莞 523500

      卷次： 2019年30卷10期

      【摘要】 目的 研究不同剂量瑞芬太尼与丙泊酚联合应用于无痛人流的效果。方法 选取东莞市企石医院2018年1月至2018年12月收治的200例自愿同意实施人工流产的早期妊娠孕妇进行研究，按照随机数表法分为A组、B组、C组、D组，每组50例。A组给予丙泊酚麻醉，B组给予丙泊酚和0.4 μg/kg瑞芬太尼麻醉，C组给予丙泊酚和0.8 μg/kg瑞芬太尼麻醉，D组给予丙泊酚和1.2 μg/kg瑞芬太尼麻醉。观察并比较四组患者麻醉前(T1)、诱导期(T2)、术中(T3)、术毕(T4)以及恢复期(T5)的平均动脉压(MAP)、呼吸频率(RR)、心率(HR)及血氧饱和度(SpO2)水平，同时比较四组患者的唤醒时间、离院时间、用药量以及不良反应发生情况。结果 A组与B组患者T1、T2、T3、T4及T5时点的MAP、HR、RR、SpO2水平比较差异均无统计学意义(P>0.05)，而C组、D组患者T2和T3时点的MAP、HR、RR、SpO2水平均明显高于A组与B组，且C组显著高于D组，差异均有统计学意义(P<0.05)；A组与B组患者的唤醒时间、离院时间及用药量比较差异均无统计学意义；C组与D组的唤醒时间、离院时间以及用药量比较差异亦均无统计学意义(P>0.05)；而C组患者的唤醒时间、离院时间分别为(2.13±1.04) min、(11.54±3.56) min，D组分别为(2.28±1.17) min、(12.29±2.14) min，均明显短于A组的(4.61±2.33) min、(18.91±3.45) min和B组的(4.56±2.36) min、(18.54±3.38) min，且C组用药量为(2.01±074) mg/kg，D组为(1.89±0.52) mg/kg，亦明显少于A组的(3.18±0.65) mg/kg和B组的(3.05±0.62) mg/kg，差异均有统计学意义(P<0.05)；D组患者的呼吸抑制等麻醉不良反应发生率为50.0%，明显高于A组的22.0%、B组的22.0%和C组的20.0%，差异均有统计学意义(P<0.05)。结论 0.8 μg/kg瑞芬太尼与丙泊酚联合应用于无痛人流患者临床效果显著，其不仅能够有效缩短患者术后苏醒时间，提高镇痛效果，还可减少麻醉使用剂量以及术后不良反应，临床应用价值较高。
      【关键词】 不同剂量；瑞芬太尼；丙泊酚；无痛人流；临床疗效
      【中图分类号】 R169.42 【文献标识码】 A 【文章编号】 1003—6350（2019）10—1297—04

Effect of different doses of remifentanil combined with propofol on painless abortion.
LI Yang, OU Zhi-rong, CHENYang-yi, GAO Gui-feng. Department of Anesthesiology, Dongguan Qishi Hospital, Dongguan 523500, Guangdong, CHINA
【Abstract】 Objective To study the effect of different doses of remifentanil combined with propofol on pain-less abortion. Methods A total of 200 pregnant women of early pregnancy who agreed to receive abortion in DongguanQishi Hospital from January 2018 to December 2018 were selected and randomly divided into group A, group B, groupC, and group D according to random number table, with 50 cases in each group, which were given propofol, propofoland 0.4 μg/kg remifentanil, propofol and 0.8 μg/kg remifentanil, propofol and 1.2. μg/kg remifentanil for anesthesia, re-spectively. The mean arterial pressure (MAP), respiratory rate (RR), heart rate (HR), and blood oxygen saturation (SpO2)levels at pre-anesthesia (T1), at induction (T2), during surgery (T3), at the end of surgery (T4), and at recovery (T5) wereobserved and compared among the four groups, as well as the wake-up time, discharge time, dosage, and the occurrenceof adverse reactions. Results There was no significant difference in MAP, HR, RR, and SpO2 levels at T1, T2, T3, T4,and T5 between group A and group B (P>0.05). The levels of MAP, HR, RR, and SpO2 at T2 and T3 in group C andgroup D were significantly higher than those in group A and group B, and the levels in group C was significantly higherthan those in group D, all with statistically significant differences (P<0.05). There was no significant difference inwake-up time, discharge time, and dosage between group A and group B, and also between group C and group D (P>0.05). The wake-up time, discharge time were (2.13±1.04) min, (11.54±3.56) min in group C, and (2.28±1.17) min,(12.29±2.14) min in group D, which were all significantly shorter than (4.61±2.33) min, (18.91±3.45) min in group A and(4.56±2.36) min, (18.54±3.38) min in group B (P<0.05). The dosage was (2.01±074) mg/kg in group C and (1.89±0.52) mg/kg in group D, significantly less than (3.18±0.65) mg/kg in group A and (3.05±0.62) mg/kg in group B (P<0.05).The incidence of adverse reactions (such as respiratory depression) in group D was 50.0%, significantly higher than 22.0%in group A, 22.0% in group B, and 20.0% in group C (P<0.05). Conclusion 0.8 μg/kg remifentanil combined with propo-fol is clinically effective in patients with painless abortion, which can not only effectively shorten the recovery time of pa-tients, improve the analgesic effect, but also reduce the dosage of anesthesia and postoperative adverse reactions.
      【Key words】 Different doses; Remifentanil; Propofol; Painless abortion; Clinical efficacy