异丙酚麻醉用于中止8-14周妊娠的临床研究

Clinical investigation of anesthesia with propofol in artificial abortion for 8-14 weeks pregnancy

目的探讨对孕8-14周中止妊娠行钳刮手术患者,在使用米非司酮和米索前列醇以后应用异丙酚无痛技术的安全性和优缺点。方法将孕8-14周需中止妊娠的80例孕妇随机分为两组(n=40):A组不用异丙酚,B组使用异丙酚(初始量2.5mg/kg,追加量0.5mg/kg/次)。所有患者术前3天口服米非司酮至总量150mg,术前30min直肠内用米索前列醇400μg。观察两组血流动力学变化、术中失血量、宫颈软化程度、手术时间、术后10min疼痛评分、患者满意程度等指标。结果B组血压、心率较A组稳定,A组术中出现脉搏血氧饱和度下降者较多,但面罩给氧后可迅速恢复。与A组相比,B组手术时间较短,术后10min疼痛评分低,病人满意程度较高,宫颈软化也较好。结论异丙酚静脉麻醉用于钳刮手术是安全、有效的,并且与米非司酮和米索前列醇联合应用时有促进宫颈软化的协同作用。

Objective To discuss the safety, advantages and disadvantages of analgesia with propofol in artificial abortion in 8-14 weeks pregnancy, after using mifepristone and misoprostol. Methods Eighty paturients at 8-14 weeks pregnancy were randomized into two groups （n=40）： no anesthesia （group A） and anesthesia with propofol at the loading dose of 2.5 mg/kg and additive dose of 0.5 mg/kg each time （group B）. All the patients were premedicated with 150mg mifepristone in 3 preoperative days and intrarectal 400 （g misoprostol at 30min preoperatively. The hemodynamic changes, volume of blood loss, softness of uteral cervix, operation time, VAS at postoperative 10min and satisfaction score of each patient were observed. Results The blood pressnre and heart rate in group B were more stable in group B than those in group A. More patienls in group A showed decreased pulse oxygen saturation, but all conld recover under mask oxygen supply. Comparing to patients in group A, those in group B showed shorter operation time, lower VAS at postoperative 10min, higher patient satisfaetin score and more softened uteral cervix. Conclusions Intravenous anesthesia with propofol is safety and effective in C ＆ D. Propofol had cooperative effect with mifepristone and misoprostol in sorting the uterus cervix.