不同麻醉方法用于无痛人工流产术的效果评估及对血浆应激激素的影响

Effects of different analgesic techniques on analgesic artificial abortion and plasma stress hormone

目的观察比较不同麻醉方法用于无痛人工流产术的效果及对血浆应激激素的影响。方法60例要求人工流产的早孕妇女,ASAⅠ级,随机均分为丙泊酚静注组(P组),七氟醚吸入组(S组)和丙泊酚诱导、七氟醚维持组(PS组)。观察各组的麻醉诱导速度、苏醒时间、定向力恢复时间、术中肢动情况及呼吸和循环变化。监测术前、术毕即刻血浆肾素(Rn)、血管紧张素Ⅰ(AⅠ)、血管紧张素Ⅱ(AⅡ)和皮质醇(Cor)的浓度。结果P组与PS组的诱导快于S组(P<0.05),苏醒时间及定向力恢复时间S组略短于其他两组,但差异无统计学意义。S组肢体扭动和呼吸抑制发生率明显低于P组和PS组(P<0.05);各组术中、术毕血压均显著下降(P<0.05)。三组AⅠ、AⅡ术毕均高于术前(P<0.05);S组AⅠ、AⅡ在术前与术毕时均高于P组(P<0.05),S组AⅠ在术前与术毕时亦高于PS组(P<0.05)。三组Rn和Cor在术毕时较术前也有所升高,但差异无统计学意义。结论七氟醚用于人工流产术镇静镇痛效果强、苏醒完全、呼吸、循环抑制等不良反应极少,其轻度的交感兴奋作用更有利于围麻醉期的血流动力学平稳,是可供选择的一种替代方法。

Objective To compare the effect of different analgesic techniques on analgesic artificial abortion and plasma stress hormones. Methods Sixty ASA class Ⅰ patients undergoing artificial abortion were randomly allocated into total intravenous anesthesia with propofol（group P）, sevoflurane inhalation （group S）, and anesthesia induction with propofol and maintenance with sevoflurane（group PS）. The time for induction, awakening from anesthesia, recovery of regainning orientation ability, and intraoperative body movements were recorded. Circulatoy and respiratory functions were monitored. The plasma levels of renin（Rn）,angiotensin Ⅰ and Ⅱ （AⅠ and AⅡ ） and cortisol（Cor ）were measured before and after operation. Results The time for induction in group P and PS was shorter than that in group S（P〈0. 05）. The recovery time and the time to regainning orientation ability was slightly shorter in group S than those in the other two groups. The incidence of body movements and respiratory depression were significantly lower in group S than those in group P and PS（P〈0.05）. Postoperative AⅠ and AⅡ were higher than those before operation in all groups （P〈0.05）. Preoperative and postoperative AⅠ and AⅡ were higher in group S than those in group P （P〈 0.05）. Preoperative and postoperative AⅠ were higher in group S than those in group PS （P〈0.05）. There was no significant difference in Rn and Cor between pre-and postoperative levels in all groups. Conclusion Sevoflurane has efficient and intensive analgesic effect and little side effects for analgesic artificial abortion. The mild sympatetic excitation of sevoflurane has an advantage to maintain stable hemodynamics perioperatively.