术前应用不同抗胆碱药对异丙酚用于无痛人流麻醉过程中某些不良事件的影响

Effects of different anticholinergic premedicants on incidence of some adverse events during intravenous anesthesia using propofol for induced abortion

目的观察异丙酚静脉全麻用于无痛人流时术前应用不同抗胆碱药对麻醉过程中某些不良事件发生的影响。方法150例年龄18～34岁、体重42～70kg、ASAⅠ级拟接受无痛人流手术的病人随机分成三组,每组50例。阿托品组病人麻醉前30min肌注阿托品0.5mg,东莨菪碱组病人麻醉前30min肌注东莨菪碱0.3mg,对照组生理盐水组病人麻醉前30min肌注生理盐水1ml。每例病人麻醉时静脉注射异丙酚2.5mg/kg,手术后根据病人身体对手术刺激的反应情况必要时追加药物,每次3ml直至病人手术时安静不动。观察每例病人麻醉过程中有无流涎过多、心动过缓和苏醒期躁动等不良事件的发生。结果阿托品组、东莨菪碱组和生理盐水组病人流涎过多发生率分别为2.0%、2.0%和16.0%;心动过缓发生率分别为4.0%、2.0%和6.0%;苏醒期躁动发生率分别为6.0%、4.0%和4.0%。阿托品组和东莨菪碱组病人流涎过多的发生都明显少于生理盐水组(P<0.05),而阿托品组和东莨菪碱组之间相比流涎过多的发生没有显著性差异(P>0.05);分别就心动过缓和苏醒期躁动的发生来说,三组中的任意两组相比都没有显著性差异(P>0.05)。结论术前肌注阿托品0.5mg或东莨菪碱0.3mg都能明显地降低异丙酚静脉全麻用于无痛人流时病人流涎过多不良事件的发生,但两者都不能降低心动过缓和苏醒期躁动不良事件的发生。

Objective To determine the effects of different anticholinergic premedicants on incidence of some adverse events during intravenous anesthesia using propofol for induced abortion. Methods 150 ASA Ⅰ patients, aged 18-34yr, weighing 42-70kg, presenting for induced abortion under intravenous anesthesia using propofol, were randomized into 3 groups：atropine group（n=50）;scopolamine group（n=50）： normal saline group（control group, n=50）.Each patient of atropine group and of scopolamine group received, respectively, atropine 0.5mg and scopolamine 0.3mg intramuscularly 30min before anesthesia. Each patient of normal saline group received normal saline lml intramuscularly 30min before anesthesia. Afterwards each patient was anesthetized with propofol 2.5mg· kg^-1 intravenously. After the operation started, if necessary, a supplementary dose of 3ml of propofol was infused each time according to the patients＇ somatic response to operation until they became quiet. Each patient was observed to find out if some adverse events including hypersalivation, bradycardia and emergence agitation occurred during anesthesia. Results Incidence rates of hypersalivation of the patients of atropine group, scopolamine group and normal saline group were respectively 2.0%,2.0% and 16.0%; Incidence rates of bradycardia were respectively 4.0%,2.0% and 6.0%; Incidence rates of emergence agitation were respectively 6.0%,4.0% and 4.0%The incidence of hypersalivation of the patients of atropine group was significantly less than that of the patients of normal saline group（P〈0. 05）,so was the incidence of hypersalivation of the patients of scopolamine group（P〈0. 5）,but the incidence of hypersalivation did not differ significantly between atropine group and scopolamine group（P〉0.05）.As to the incidence of either bradycardia or emergence agitation, compared anyone with another there was no significant difference, among three groups（P〉0. 05）. Conclusion Both premedication with atropine 0. 5mg intramuscularly and premedication with scopolamine 0.3mg intramuscularly can decrease incidence of hypersalivation, but neither of them can decrease incidence of bradycardia or emergence agitation,