基于多准则决策的不同剂量瑞马唑仑联合阿芬太尼应用于无痛人工流产术的风险-效益评价  

Risk-benefit evaluation of different doses of Remimazolam combined with Alfentanil in painless induced abortion based on the multi-criteria decision

作　　者：林卫欣 孙虎[1] 吕淞[1] 陈乔芳 徐志新 Lin Weixin;Sun Hu;Lyu Song;Chen Qiaofang;Xu Zhixin(Department of Anesthesiology,the Second Affiliated Hospital of Hainan Medical College,Hainan,Haikou 570100,China)

机构地区：[1]海南医学院第二附属医院麻醉科,海南海口570100

出　　处：《发育医学电子杂志》2024年第5期328-336,共9页Journal of Developmental Medicine (Electronic Version)

摘　　要：目的基于多准则决策模型来评价不同剂量瑞马唑仑联合阿芬太尼应用于无痛人工流产术的风险-效益。方法前瞻性选取2020年6月至2022年2月在海南医学院第二附属医院进行人工流产术的136例孕妇作为研究对象,根据随机数字表法将孕妇分为A组、B组、C组和D组,每组各34例。A组孕妇采用丙泊酚联合阿芬太尼麻醉,B组、C组和D组孕妇分别采用不同剂量(0.1 mg/kg、0.15 mg/kg、0.2 mg/kg)瑞马唑仑联合阿芬太尼麻醉。建立无痛人工流产麻醉效果的多准则决策模型。统计学方法采用独立样本t检验、方差分析、χ^(2)检验。结果D组孕妇的麻醉起效时间短于A组和B组[(1.6±0.4)min与(2.3±0.6)min、(2.0±0.4)min,t值分别为2.634、2.548,P值均<0.05)]。D组孕妇术后疼痛视觉模拟评分(visual analogue scale,VAS)低于A组、B组和C组[(3.8±0.3)分与(4.5±0.8)分、(4.7±0.8)分、(4.5±0.5)分,t值分别为4.085、3.293、3.169,P值均<0.05)]。A组和D组孕妇的Ramsay评分分别为(5.4±0.5)分和(5.4±0.5)分,均高于B组[(4.6±0.4)分]和C组[(4.8±0.4)分](A组和B组、C组间的t值分别为3.516、3.748,D组和B组、C组间的t值分别为3.976、4.526,P值均<0.05)。麻醉后(T1),A组孕妇的平均动脉压(meanarterialpressure,MAP)为(59.4±4.4)mmHg(1mmHg=0.133kPa)、心率(heartrate,HR)为(73.3±6.3)次/min、血氧饱和度(oxygensaturation,SpO_(2))为(87.2±4.4)%、呼吸频率(respiratory rate,RR)为(11.4±2.3)次/min、脑电双频指数(bispectral index,BIS)为56.3±5.8,波动幅度较其他3组显著(A组和B组间的t值分别为8.237、2.835、2.823、2.857、3.257,A组和C组间的t值分别为8.574、2.674、2.457、2.632、3.485,A组和D组间的t值分别为8.634、2.823、2.162、2.934、5.238,P值均<0.05)。应用Meta分析方法分别合并4组的结果发现,与A组、B组、C组相比,D组孕妇的麻醉起效时间、Ramsay评分、术后VAS评分、MAP、HR、SpO_(2)、RR以及BIS均显著改善,总有效率显著升高,不�Objective To evaluate the risk-benefit of different doses of Remimazolam combined with Alfentanil in painless induced abortion based on the multi-criteria decision model.Method A total of 136 pregnant women who underwent induced abortion surgery at the Second Affiliated Hospital of Hainan Medical University from June 2020 to February 2022 were prospectively selected as the study subjects.According to the random number table,the pregnant women were divided into group A,group B,group C and group D,with 34 cases in each group.The pregnant women in group A were anesthetized with Propofol combined with Alfentanil,and the pregnant women in group B,group C and group D were anesthetized with different doses of Remimazolam(0.1 mg/kg,0.15 mg/kg,0.2 mg/kg)combined with Alfentanil.A multi-criteria decision model for anesthesia effect of painless induced abortion was established.Statistical methods performed by independent sample t-test,ANOVA andχ^(2) test.Result The onset time of anesthesia in group D was shorter than that in group A and group B[(1.6±0.4)min vs(2.3±0.6)min vs(2.0±0.4)min,t=2.634,2.548,all P<0.05].The visual analogue scale(VAS)score of postoperative pain in group D was lower than that in group A,group B and group C[(3.8±0.3)points vs(4.5±0.8)points vs(4.7±0.8)points vs(4.5±0.5)points,t=4.085,3.293,3.169,all P<0.05].The Ramsay scores of group A and group D were(5.4±0.5)points and(5.4±0.5)points,respectively,which were higher than those in group B[(4.6±0.4)points]and group C[(4.8±0.4)points](group A vs group B and group C,t=3.516,3.748;group D vs group B and group C,t=3.976,4.526,all P<0.05).After anesthesia(T1),the mean arterial pressure(MAP)of group A was(59.4±4.4)mm Hg(1mm Hg=0.133 kPa),heart rate(HR)was(73.3±6.3)times/min,oxygen saturation(SpO_(2))was(87.2±4.4)%,respiratory rate(RR)was(11.4±2.3)times/min,and bispectral index(BIS)was 56.3±5.8,thefluctuations range was significant compared with the other three groups(group A vs group B,t=8.237,2.835,2.823,2.857,3.257;group A vs group C,t=8.57

关 键 词：多准则决策 无痛人工流产 瑞马唑仑 阿芬太尼 效益 风险 

分 类 号：R614[医药卫生—麻醉学]