异丙酚复合瑞芬太尼靶控输注在人工流产中应用研究.docVIP

异丙酚复合瑞芬太尼靶控输注在人工流产中应用研究【摘要】　对比不同血浆靶控浓度异丙酚复合瑞芬太尼在无痛人工流产中应用效果。行人工流产患者400例，随机分为R0、R1、R2、P0组即异丙酚3.0、2.0、1.5、0 μg/ml复合瑞芬太尼0、0.5、1.0、2.0 ng/ml组。监测无创血压、心率、心电图和脉搏血氧饱和度，分别记录患者意识消失时间和恢复时间，并记录术中体动情况和术后主观感觉评分。结果　R1、R2组恢复时间明显短于R0组。R0、R1组主观感觉评分明显优于R2、P0组。 结论　异丙酚与瑞芬太尼合用具有协同作用，但作用机制不同。以血浆靶控浓度2.0 μg/ml异丙酚复合0.5 ng/ml瑞芬太尼效果最佳。 【关键词】　异丙酚；瑞芬太尼；血浆靶控；主观感觉评分 【Abstract】　Objective　To compare the effects of target-controlled infusion(TCI) of propofol combination of remifentanil invarious doses in patients undergoing painless abortion .Methods　400 ASA Ⅰ-Ⅲ patients aged 24-38yr, undergoing painless abortion were randomly divided into four groups: group R0，R1，R2，P0 were received propofol at a fixed target plasma concentration of 3.0, 2.0, 1.5, 0 μg/ml combination of remifentanil at 0, 0.5, 1.0, 2.0 ng/ml, until loss of consciousness. The time required for loss of consciousness after TCI of propofol and remifentanil was started (TLOC), for recovery of consciousness (TROC) after TCI of propofol and remifentanil was stopped were recorded. Ramsay score and subject emotional experience score were also assessed. MAP, HR, ECG, SpO?2 were monitored during anesthesia.Results　TROC was significantly shorten in group R1, R2 than group R0. Subjective emotional experience score was better in group R0, R1 than ingroup R2, P0. MAP, SpO?2, HR of similar magnitude reduced in four groups, but no serious cardiac and respiratory adverse effect were observed.Conclusion　 Propofol potentiates remifentanil when given by TCI simultaneously for painless abortion. The target plasma propofol concentration of 2.0 μg/ml in the presence of plasma remifentanil concentration of 0.5 ng/ml is the appropriate target concentration, it can effectively attenuate the abortion response and patients feel better. 【Key words】　Propofol；Remifentanil；Target-controlled；Infusion(TCI) subjective emotional experience 异丙酚和瑞芬太尼均具有起效快、半衰期短的特点，适合于门诊联合靶控输注［1，2］。拟通过观察不同剂量异丙酚复合瑞芬太尼在无痛人工流产中应用，为门诊合理应用提供参考。 1　资料与方法 行无痛人工流产的患者400例，ASAⅠ～Ⅲ级、