丙泊酚联合不同麻醉药在人工流产术中的临产观察(1)

http://www.100md.com 2010年5月1日 田蜜 杨建军 李伟彦

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     【摘要】目的:观察丙泊酚联合芬太尼、曲马多或瑞芬太尼用于人工流产手术的麻醉效果，探讨较佳配方。方法:选择门诊拟行人工流产孕妇150例，ASA I~II级，随机分为三组(n=50)：A组为丙泊酚+芬太尼组，B组为丙泊酚+曲马多组，C组为丙泊酚+瑞芬太尼组。观察三组病人术前、术中的平均动脉压(MAP)、呼吸(R)、心率(HR)、血氧饱和度(SPO2)及所用丙泊酚总量和苏醒时间、幻觉、注射痛、术中体动次数和程度及术毕镇痛效果。结果:三组患者对镇痛效果均满意，三组丙泊酚总用量及产生幻觉人数无统计学意义。三组麻醉后均有循环呼吸抑制，术中MAP、 R、HR、SPO2均较术前未用药时降低(P<0.05)，A组呼吸抑制较B组和C组明显(P<0.05)，C组苏醒时间短于A组和B组。C组的注射痛明显低A组合B组。(P<0.01)。结论:芬太尼、曲马多、瑞芬太尼均可联合丙泊酚安全有效地用于无痛人流手术，瑞芬太尼联合丙泊酚用于无痛人工流产术，麻醉效果更满意，不良反应少。

    【关键词】麻醉； 丙泊酚； 芬太尼； 曲马多； 瑞芬太尼； 人工流产术

    【中图分类号】R971.2 【文献标识码】A 【文章编号】1008-6455(2010)11-0025-02

    【Abstract】Objective:To study the effect of fentanyl, tramadol and remifentanil combined with propofol for painless artificial abortion,in order to study the best compatibility of anesthetics. Methods: 150 pregnant women from outpatient, ASA I~II, were randomly divided into three groups (50 in each group): A group of propofol mixed with fentanyl, B group of propofolmixed with tramadol, C group of propofol mixed with remifentani. To study mean arterial pressure (MAP), respiration (R), heart rate (HR), oxygen saturation (SpO2) of three groups of patients before and during the operation, and the total amount of propofol and the recovery time, hallucinations, injection pain, surgery and body movement frequency and the extent of analgesic effect of surgery. Results: The analgesic effect of three groups patients were satisfied,but the total amount of propofol and the number of hallucinations have no significant. After anesthesia three groups patients were depressed in circulating and respiratory, intraoperative MAP, R, HR, SPO2 were decreased less than preoperative medication(P <0.05). There was an significantly depression in respiratory in A group than in B group and C group (P<0.05),but the recovery time in C group is shorter than A group and B group. and compared with A group and B group, C group injection pain was significantly lower(P<0.01). Conclusion: Fentanyl, tramadol, remifentanil combined with propofol can be safely and effectively used for painless artificial abortion, T he effect of remifentanil combined with propofol was better than the other two methods in painless abortion，and with less side effects ......

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