CAJ | 학술논문

目的：探讨靶控输注丙泊酚复合瑞芬太尼、地佐辛用于无痛人工流产术的有效性和安全性。方法选择60例美国麻醉医师协会（ ASA）分级Ⅰ～Ⅱ级行无痛人工流产术的患者，将患者完全随机分为2组，靶控输注丙泊酚组（ TCI组）和手控输注丙泊酚组（ MCI组），每组30例。 TCI组设定丙泊酚初始血浆靶浓度为6 mg/L，术中根据手术进程滴定目标靶浓度；MCI组以丙泊酚2 mg/kg诱导，术中发生体动反应时追加丙泊酚20～30 mg。2组均在术前5 min静脉滴注地佐辛5 mg，入睡后即刻小壶滴注瑞芬太尼1μg/kg。观察并记录2组丙泊酚的总用量、麻醉效能、术中呼吸循环的变化及术后不良反应等指标。结果 TCI组丙泊酚的总用量为（2．55±0．34）mg/kg，明显大于MCI组的（2．10±0．20）mg/kg（P＜0．01）；TCI组麻醉效果优的比例高于MCI组[83．3％（25/30）比53．3％（16/30），P＜0．05]、术中体动反应的发生率低于MCI组[16．7％（5/30）比46．7％（14/30），P ＜0．05]；除诱导时间 TCI 组[（1．27±0．15） min]长于 MCI 组[（1．09±0．15）min]外，2组患者的手术时间、意识恢复时间、清醒时间差异均无统计学意义；麻醉诱导后，2组患者的平均动脉压、心率均下降（均P＜0．01），但2组间差异无统计学意义（P＞0．05），术毕时平均动脉压均回升至术前水平；2组患者均无明显的术后宫缩痛。结论丙泊酚靶控输注复合瑞芬太尼、地佐辛用于无痛人工流产术麻醉效果安全舒适，麻醉深度易于控制，但术中须注意对患者呼吸功能的支持。
목적：탐토파공수주병박분복합서분태니、지좌신용우무통인공유산술적유효성화안전성。방법선택60례미국마취의사협회（ ASA）분급Ⅰ～Ⅱ급행무통인공유산술적환자，장환자완전수궤분위2조，파공수주병박분조（ TCI조）화수공수주병박분조（ MCI조），매조30례。 TCI조설정병박분초시혈장파농도위6 mg/L，술중근거수술진정적정목표파농도；MCI조이병박분2 mg/kg유도，술중발생체동반응시추가병박분20～30 mg。2조균재술전5 min정맥적주지좌신5 mg，입수후즉각소호적주서분태니1μg/kg。관찰병기록2조병박분적총용량、마취효능、술중호흡순배적변화급술후불량반응등지표。결과 TCI조병박분적총용량위（2．55±0．34）mg/kg，명현대우MCI조적（2．10±0．20）mg/kg（P＜0．01）；TCI조마취효과우적비례고우MCI조[83．3％（25/30）비53．3％（16/30），P＜0．05]、술중체동반응적발생솔저우MCI조[16．7％（5/30）비46．7％（14/30），P ＜0．05]；제유도시간 TCI 조[（1．27±0．15） min]장우 MCI 조[（1．09±0．15）min]외，2조환자적수술시간、의식회복시간、청성시간차이균무통계학의의；마취유도후，2조환자적평균동맥압、심솔균하강（균P＜0．01），단2조간차이무통계학의의（P＞0．05），술필시평균동맥압균회승지술전수평；2조환자균무명현적술후궁축통。결론병박분파공수주복합서분태니、지좌신용우무통인공유산술마취효과안전서괄，마취심도역우공제，단술중수주의대환자호흡공능적지지。
Objective To evaluate the efficacy and safety of propofol by target-controlled infusion (TCI) combined with remifentanil and dezocine for artificial abortion .Methods According to the different anesthesia , sixty patients were randomly divided into two groups in chronological order ( n=30 each ):group TCI and group manual-controlled infusion (group MCI).The initial target plasma concentration of group TCI was 6 mg/L, titra-ting the goal target concentration during the surgical process .The induction dose of propofol was 2 mg/kg in group MCI, supplying propofol by 20-30 mg.5 mg dezocine was infused 5 minutes before anesthesia and 1 μg/kg remifentanil was infused immediately after sleeping for each group .The anesthetic effect , change of respiration and circulation , total dose of propofol and side-effect of operation were observed and recorded .Results Total dose of propofol used in group TCI was (2.55 ±0.34) mg/kg,which was significantly more than that of group MCI [(2.10 ±0.20)mg/kg] (P<0.01).Compared with group MCI, the ratio of excellent anesthesia in group TCI was higher [83.3%(25/30) vs 53.3%(16/30), P<0.05], and the incidence of body movement was less in group TCI [16.7%(5/30) vs 46.7%(14/30), P<0.05].The induced time in group TCI was (1.27 ± 0.15)min, which was longer than that of group MCI [(1.09 ±0.15) min, P<0.01], but there was no signifi-cant difference in the recovery time between the two groups .The mean arterial pressure ( MAP) and heart rate (HR) were lower after induction (P<0.01), but the MAP returned to normal at the end of surgery in both groups.The changes of MAP and HR in group TCI and group MCI were not significantly different (P>0.05).No severe postoperative pain from uterine contraction occurred in all the patients .Conclusions Target-controlled in-fusion of propofol combined with remifentanil and dezocine for artificial abortion is safe and effective with good con -trollability, but respiratory support should be provided during the surgical procedure .