李信安 唐文昌 曾宪荣 张佳群 邹素姣

[摘要] 目的 研究丙泊酚复合芬太尼用于无痛人工流产麻醉时的最佳配伍方案。 方法 选取我院2014年5月～2015年8月收治的ASAⅠ～Ⅱ级行无痛人工流产患者200例，随机分为4组，每组50例。丙泊酚分别复合0.05（A组）、0.1（B组）、0.15 μg/kg（C组）的芬太尼进行人工流产麻醉，D组单纯给予丙泊酚进行麻醉。观察MAP、HR、SpO2，记录丙泊酚追加剂量、术中镇痛效果、清醒时间、术后宫缩痛及术中知晓、梦幻、恶心、呕吐等不良反应的发生率。 结果 A、B、C 组的镇痛效果优于D组，B、C组的镇痛效果优于A组（P<0.05）。与术前比较，A、B组术中的MAP、HR、SpO2均稍有下降，但差异无统计学意义（P>0.05），C组术中的MAP无明显变化（P>0.05），HR、SpO2均明显下降（P<0.05），D组术中的MAP、HR、SpO2均明显下降（P<0.01）。4组术前的MAP、HR、SpO2比较差异无统计学意义（P>0.05），A、B、C组与D组术中的MAP、HR、SpO2比较，差异有统计学意义（P<0.05）。B、C组的丙泊酚追加剂量明显少于A组（P<0.05），B、C组间差异无统计学意义（P>0.05）；B、C组的清醒时间明显短于A组（P<0.05），B、C组间差异无统计学意义（P>0.05）。与D组比较，A、B、C组的丙泊酚追加剂量较少，清醒时间较短，差异无统计学意义（P>0.05）。A、B、C组术后宫缩痛发生率与D组比较，差异有统计学意义（P<0.05）。4组的并发症发生率差异无统计学意义（P>0.05）。 结论 丙泊酚复合0.1 μg/kg的芬太尼用于无痛人工流产的麻醉效果确切、安全、并发症少，值得临床推广 。

[关键词] 丙泊酚；芬太尼；无痛人工流产

[中图分类号] R169.42 [文献标识码] A [文章编号] 1674-4721（2016）03（b）-0135-03

Application effect of propofol combined with fentanyl in painless artificial abortion

LI Xin-an1 TANG Wen-chang1 ZENG Xian-rong1 ZHANG Jia-qun1 ZOU Su-jiao2

1.Department of Anesthesiology，Shiyan People′s Hospital of Baoan District in Shenzhen City，Shenzhen 518108，China；2.Operation Room，People′s Hospital of Luohu District in Shenzhen City，Shenzhen 518001，China

[Abstract] Objective To study the best combination scheme of propofol combined with fentanyl applied in anaesthesia of painless artificial abortion. Methods 200 patients with ASA gradeⅠ-Ⅱ conducted painless artificial abortion and treated by our hospital from May 2014 to August 2015 were selected and they were randomly divided into four groups，and there were 50 cases in each group. Anaesthesia of painless artificial abortion was conducted with propofol combining with 0.05 μg/kg （group A），0.1 μg/kg （group B）， 0.15 μg/kg （group C） of fentanyl，and group D was given simple propofol to conduct anaesthesia.MAP，HR and SpO2 was observed respectively，while additional dose of propofol，analgesic effect during operation，awake time，postoperative uterine contraction pain and incidence rate of adverse reaction such as intraoperative awareness，fantasy，nausea，vomiting and so on was recorded respectively. Results Analgesic effect of group A，B and C was better than that of group D （P<0.05），and analgesic effect of group B and C was better than that of group A （P<0.05）.Compared with before operation，MAP，HR，SpO2 during operation in group A and B was decreased slightly，but there was no statistical difference （P>0.05），and MAP in group C had no obvious change during operation （P>0.05），HR，SpO2 was significantly decreased respectively （P<0.05）；MAP，HR，SpO2 during operation in group D was significantly decreased （P<0.01）.There was no statistical difference of MAP，HR，SpO2 before operation among 4 groups （P>0.05），and there was a statistical difference of MAP，HR，SpO2 during operation in group A，B and C compared with group D respectively （P<0.05）.Additional dose of propofol in group B and C was significantly fewer than that of group A （P<0.05），and there was no statistical difference between group B and C （P>0.05）；awake time in group B an C was significantly shorter than that in group A （P<0.05），and there was no statistical difference between group B and C （P>0.05）.Compared with group D，additional dose of propofol was fewer and awake time was shorter in group A，B and C，but there was no statistical difference （P>0.05）.There was a statistical difference of incidence rate of uterine contraction pain after operation in group A，B and C compared with group D P<0.05）.There was no statistical difference of incidence rate of complication among 4 groups （P>0.05）. Conclusion Anesthesia effect is exact of propofol combining with 0.1 μg/kg of fentanyl for painless artificial abortion，and it is safe with fewer complications.It is worthy of clinical promotion.

[Key words] Propofol；Fentanyl；Painless artificial abortion

近年来，随着社会的发展，人工流产的人逐年增加，但人工流产会给患者造成一定的疼痛及不适感，因此无痛人工流产逐渐成为主流，成为妇科常规的门诊手术。目前，用于无痛人工流产麻醉的各种药物配伍方法很多，其中丙泊酚是最常用的麻醉药物，但丙泊酚镇痛效果差，作用时间短，遇疼痛等强烈刺激时需追加丙泊酚以加深镇静来对抗，且术后常有苏醒延迟、子宫收缩痛等不良反应。芬太尼是阿片类制剂中镇痛效应最强的药物，且起效快、苏醒时间短[1]，较适于复合丙泊酚联合用于门诊人工流产术的麻醉[2]。本研究旨……