目的：比较丙泊酚、依托咪酯复合芬太尼、咪达唑仑用于无痛人工流产术的麻醉效果及不良反应,探讨安全、舒适的人工流产术麻醉方案。方法选择自愿行无痛人工流产术的女性160例(孕周6~10周),随机分为4组(n=40)：丙泊酚复合芬太尼及咪达唑仑组(PMF)、丙泊酚复合芬太尼组(PF)、依托咪酯复合芬太尼及咪达唑仑组( EMF)及依托咪酯复合芬太尼组( EF)。 PMF组和EMF组于麻醉前2 min静脉注射咪达唑仑0．02 mg/kg,PF组与EF组则静脉注射生理盐水1 mL作为对照；2 min后各组均静脉推注芬太尼1μg/kg,注射完毕2 min后,P组静脉注射丙泊酚2 mg/kg,E组静脉注射依托咪酯0．2 mg/kg。记录各组入室(T1)、预给后(T2)、诱导期(T3)、追加期(T4)、结束时(T5)、苏醒时(T6)的平均动脉压(MAP)、心率(HR)和血氧饱和度(SpO2)。并记录诱导至第1次追加时间(t1)、末次给药至睁眼时间(t2)、末次给药至应答时间(t3)、末次给药至自行走动时间(t4)、手术时间(ST)、术毕至睁眼时间(SZ)；丙泊酚和依托咪酯计算总量(SUM),丙泊酚和依托咪酯经体重、手术时间校正后的总量(SWM)及不良反应。结果(1)用药量：EMF组SUM、SWM小于EF组(P<0．05或0．01)；PMF组SUM、SWM小于PF组(P<0．05或<0．01)。(2)麻醉恢复时间：PMF组t2、t3大于PF组(P<0．01)、EMF组(P<0．01或0．05)；PMF组SZ大于EMF组(P<0．01)。(3) MAP：PMF、PF、EMF、EF组T3期MAP小于T1期、T4期( P<0．01)；PMF、PF、EMF、EF组T5期MAP小于T4期( P<0．01)。 EF组T4期MAP高于T1期(P<0．05),PMF、PF组T6期MAP小于T1期(P<0．05或0．01)。 PF、PMF、EMF组T3期MAP小于EF组(P<0．05或0．01)。(4)HR：PMF、PF、EMF、EF组T3期HR小于T1期(P<0．01)、T4期(P<0．01)。PMF、PF、EMF组T6期HR高于T3期(P<0．05)。(5)SpO2：PMF、PF、EF组T3期SpO2小于T1期(P<0．01)。EMF、EF组T3期SpO2均大于PMF、PF组(P<0．05或0．01)；PMF、PF组T5期SpO2小于EF组(P<0．01)。丙泊酚组注射痛发生率显著高于依托咪酯；依托咪酯组术中肌颤、术后恶心呕吐的发生率显著高于丙泊酚组,复合咪达唑仑可降低依托咪酯组上述两种不良反应的发生率。结论无痛人工流产术期间,丙泊酚对呼吸、循环系统的抑制作用明显,以诱导期最为突出,而依托咪酯在麻醉期间对呼吸、循环系统的影响较小。丙泊酚复合芬太尼、依托咪酯复合芬太尼及咪达唑仑是适于人工流产术的舒适、安全的麻醉方案。%Objective To compare the anesthetic effect and the adverse reactions of propofol and etomidate, which were combined with fentanyl or midazolam,to instruct the safe and comfortable induced abortion anaesthesia pro-gram. Methods 160 ASA Ⅰ or Ⅱ patients undergoing painless induced abortion were randomly divided into four groups(n=40):Group PF,PMF,EF and EMF. Group PMF and EMF received midazolam at 0. 02 mg/kg,then Group PF and EF received normal saline 1 mL as placebo. After two minutes,all of them received fentanyl 1 μg/kg. Two mi-nutes after being injected fentanyl,Group PF and PMF received propofol at 2 mg/kg,Group EF and EMF received eto-midate at 0. 2 mg/kg. When the body movements appeared in the operation,Group PF and PMF were injected propofol 20~40 mg per time,Group EF and EMF were injected etomidate 2~4 mg per time. MAP,HR and SpO2 were recorded at 6 time points,which were before anesthesia(T1),after the injection of midazolam or placebo(T2),after the injection of propofol or etomidate ( T3 ) , after the additional injection of propofol or etomidate ( T4 ) , when the operation being finished(T5),when the patients recovered(T6). Recovery time was recorded,which was stated as follows:the time from induction to the first additional injection(t1),the time from the last injection to the moment patients could open eyes (t2),the time from the last injection to the moment patients could answer (t3),the time from the last injection to the moment patients could walk by themselves ( t4 ) , the time from operation finished to the moment patients could open eyes ( SZ ) , the operation time ( ST ) . The calculating dosage of propofol or etomidate ( SUM ) , the dosage of propofol or etomidate after the correction of operation time and weight (SWM),adverse reactions were all recorded. Results SUM and SWM of Group EM were lower than those of Group EF(P<0. 05 or 0. 01);SUM and SWM of Group PMF were lower than those of Group P (P<0. 05 or 0. 01). The t2 and t3 of Group PMF were longer than those of Group PF(P<0. 01 or 0. 05),and Group EMF(P<0. 01 or 0. 05);The SZ of Group PMF were longer than that of Group EMF ( P <0. 01 ) . MAP of Group PMF、PF、EMF and EF at T3 were lower than those of T1 and T4 ( P <0. 01);MAP of Group PMF、PF、EMF and EF at T5 were lower than those of T4 (P<0. 01). MAP of Group EF at T4 was higher than those of T1 (P<0. 05),MAP of Group PMF and PF at T6 were lower than those of T1 (P<0. 05 or<0. 01). MAP of Group PF、PMF and EMF at T3 were lower than that of Group EF(P<0. 01 or <0. 05). HR of Group PMF、PF、EMF、EF at T3 were lower than those of T1 and T4 ( P<0. 01 ) . HR of Group PMF、PF、EMF at T6 were higher than those of T3 (P<0. 05). SpO2 of Group PMF、PF、EF at T3 were lower than those of T1(P<0. 01). SpO2 of Group EMF and EF at T3 were higher than that of Group PMF and PF(P<0. 05 or <0. 01);SpO2 of Group PMF and PF at T5 were lower than Group EF(P<0. 01). The pain of injection was higher by using propofol than u-sing etomidate. Although etomidate would cause myoclonus and nausea&vomit after operation,combined with midazo-lam would reduce them. Conclusion During the painless induced abortion,the inhibition of the respiratory and circula-tory system of propofol is obvious,especially in the induction process. However,it is much less by using etomidate. The anaesthesia programs which constituted by propofol and fentanyl,or etomidate,fentanyl and midazolam are all comfort-able and safe.
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