瑞芬太尼联合依托咪酯和丙泊酚在无痛人工流产麻醉中的应用

Application of remifentanil plus propofol-etomidate anesthesia in painless abortion

摘要:

目的：观察单次静脉注射瑞芬太尼复合丙泊酚、瑞芬太尼复合依托咪酯和瑞芬太尼复合依托咪酯混合丙泊酚用于人工流产麻醉的效果，探寻一种用于无痛人流的理想麻醉方式。方法：ASAⅠ~Ⅱ级自愿接受无痛人流的早孕女性300例，随机分为丙泊酚组（P组）、依托咪酯组（E组）和依托咪酯混合丙泊酚组（EP组），记录每组麻醉前（T0）、麻醉后1 min（T1）、操作开始后1 min（T2）和术后1 min（T3）的平均动脉压（mean arterial pressure，MAP）、心率（heart rate，HR）、脉搏血氧饱和度（percutaneous oxygen saturation，SpO2）；记录整个过程注射痛、肌阵挛、恶心呕吐等不良事件发生情况；分别对妇产科医生和患者本人进行麻醉效果满意度的评定。结果：在T0和T3，3组患者的MAP、HR、SpO2对比差异无统计学意义（P＞0.05），T1和T2，E组和EP组患者的MAP、HR、SpO2均高于P组（P＜0.05）；P组患者在注射痛、术中低血压和心动过缓发生率方面要高于E组和EP组（P＜0.05），E组患者在肌阵挛发生率方面要高于P组和EP组（P＜0.05）。3组患者术中体动、追加药物、恶心呕吐、低氧饱和度发生率方面，差异无统计学意义（P＞0.05）；麻醉效果满意度方面，妇产科医生对P组和EP组的满意度较高（P＜0.05），患者本人对E组和EP组的满意度更高（P＜0.05）。 结论：单次静脉注射瑞芬太尼复合EP混合液用于无痛人流麻醉，在提高术中循环呼吸稳定性，减少注射痛、肌阵挛，提高医患双方满意度方面更优于瑞芬太尼复合丙泊酚、瑞芬太尼复合依托咪酯。

Abstract:

Objective：To observe the effect of single intravenous injection of remifentanil plus propofol，remifentanil plus etomidate and remifentanil plus etomidate-propofol mixture in painless abortion anesthesia，so as to explore an ideal anesthetic method for painless abortion. Methods：A total of 300 early pregnant women of ASAⅠ-Ⅱ who accepted painless abortion voluntarily were ran－domly divided into propofol group（group P），etomidate group（group E） and etomidate mixed propofol group（group EP）. Mean arte－rial pressure（MAP），heart rate（HR） and percutaneous oxygen saturation（SpO2） before anesthesia（T0），one minute after anesthesia （T1），one minute after the operation（T2） and one minute post operation（T3） were recorded in each group. Adverse events such as in－jection pain，myoclonus，nausea and vomiting were recorded. Effect of anesthesia satisfaction were evaluated for obstetrics and gy－necology doctors and patients respectively. Results：In T0 and T3，there was no significant difference in MAP，HR and SpO2 among the three groups（P>0.05）. MAP，HR and SpO2 of group E and EP in T1 and T2 were higher than those in group P（P<0.05）；the inci－dence of injection pain，intraoperative hypotension and bradycardia in group P was higher than that in group E and group EP（P<0.05）. The incidence of myoclonus in group E was higher than that in group P and EP（P<0.05）. There was no significant difference in the incidence of intraoperative movement，additional drugs，nausea，vomiting and hypoxia saturation among the three groups（P>0.05）. In terms of satisfaction with anesthesia effect，gynecologists and obstetricians had high satisfaction with group P and EP（P<0.05），while patients themselves had higher satisfaction with the two groups（P<0.05）. Conclusion：In painless abortion，single intrave－nous injection of remifentanil plus EP mixture is a better choice than remifentanil plus propofol and remifentanil plus etomidate，in maintaining hemodynamic stability，reducing in－jection pain and myoclonus，getting higher satisfaction with surgery doctors and patients.