人工流产术几种镇痛方法的比较及选择

Comparison and choice of analgesic means in artificial abortion

目的:比较4种镇痛方法用于人工流产术的镇痛效果、不良反应及费用。方法:将200例在门诊要求人工流产术的未产早孕妇女随机分为4组:1组,先给芬太尼1μg/kg缓慢静脉注射,继以异丙酚2 mg/kg静脉缓推,待受术者意识消失后开始手术;2组,术前2 h阴道后穹窿放置未索前列醇400μg,术前1 min开始吸入笑气,手术结束时停止吸入;3组,手术开始前1 min吸入笑气,至手术结束时停止吸入;4组,术前2 h阴道后穹窿放置米索前列醇400μg,术前5 min于两侧宫旁组织分别注射1%利多卡因各2 mL,同时用浸有2%利多卡因的棉签插入宫颈内口。结果:1组镇痛有效率为100%,其中0级达90%,有1例发生呼吸暂停,人流综合征发生率为0,无阻力扩宫率为88%,麻醉费用350元。2组:镇痛有效率为96%,其中0级为60%,人流综合征发生率为0,无阻力扩宫率为100%,费用100元。3组:镇痛有效率为70%,与1、2组相比有显著性差异(P<0.05),无阻力扩宫率为70%,人流综合征发生率为4%,费用90元。4组:镇痛有效率为80%,与1、2组相比,无显著性差异(P>0.05),但0级只有10%,显著低于1、2组,无阻力扩宫率为100%,人流综合征发生率为4%,费用35元。结论:4组中,1组镇痛效果最好,但有呼吸抑制发生可能,所需费用最高;2组效果与1组相近,费用适中,4组费用最低,效果与3组相近。

Objective：To compare the effectiveness and side effects and cost on 4 kinds of analgesic means in artificial abortion. Methods： Two hundred women with early pregnancy requested for artificial abortion were randomly divided into 4 groups. In group 1, fentanyl 1μg/kg, succeed with Diprivan 2 mg/ kg, was injected slowly into vein of each participant, operation was taken till they lost awareness; In group 2, misoprostol 400μg was placed to posterior fornix pre operation 2 hrs for each, nitric oxide was inhaled pre operation 1 min, the inhalation was stopped when operation ended; In group 3, nitric oxide was inhaled pre operation 1 min, the inhalation and operation ended simultaneously; In group 4, misoprostol 400μg was placed to posterior fornix pre operation 2 hrs for each, lidocaine 2 mL in 1% was injected into two sides of parametrium pre operation 5 min, cotton swab soaked with lidocaine was inserted to cervix endostoma, simultaneously. Results：In group 1, the effective rate of analgesia was 100%, of 0 grade pain was 90%, one case had apnea, artificial abortion symptom complex rate was 0. The rate of nonresistant cervical dilatation was 88%. Anaesthesia cost 350 yuan. In group 2, the effective rate of analgesia was 96 % ,of 0 grade pain was 60 %, artificial abortion symptom complex rate was 0. The rate of nonresistance cervical dilatation was 100%. Anaesthesia cost 100 yuan. In group 3, the effective rate of analgesia was 70%, the difference was significant compared to that in group 1 and 2（P〈0.05）. The rate of nonresistance cervical dilatation was 70%, artificial abortion symptom complex rate was 4%, the cost was 90 yuan. In group 4, the effective rate of analgesia was 80%, there was no difference compared to that in group 1 and 2（P〉0.05）, of 0 grade pain was 10%, obviously lower than that in group 1 and 2, the rate of nonresistance cervical dilatation was 100%, artificial abortion symptom complex rate was 4%, the cost was 35 yuan. Conclusion： The method in group 1 has better analgesic effective, but possibly apnea and costly; the way in group 1 has similar effective and acceptable fee to that in group 1 ; the approach in group 4 has lowest fee and similar effective to that in group 3.