异丙酚复合不同镇痛药用于老年患者妇科门诊手术麻醉的观察

Clinical observation of Propofol combined with analgesics for anesthesia of elder outpatient operations in gynecology department

目的研究异丙酚复合不同镇痛药用于老年患者妇科门诊手术的麻醉作用。方法年龄55岁以上ASA分级Ⅰ～Ⅲ患者80例,随机分4组(n=20),I组先缓慢静脉注射芬太尼1μg/kg1min后静脉注射异丙酚2mg/kg。Ⅱ组先静脉注射曲马多1mg/kg1min后静脉注射异丙酚2mg/kg。Ⅲ组先静脉注射氯诺昔康0.15mg/kg5min后静脉注射异丙酚2mg/kg,IV组静脉注射异丙酚2mg/kg。四组异丙酚静注速率均为100mg/min。观察各组诱导及苏醒时间,用药总量,记录术中呼吸、循环参数改变和术中、术后不良反应。术后由手术医生评定麻醉效果。结果手术全程异丙酚给药量及术毕至唤醒时间对照组高于其他各组。I组术中最低SpO2值在85%～90%之间或小于85%的病例数均多于其他组(P<0.05),I、Ⅱ组术中舌根后坠、术后恶心、呕吐发生率高于Ⅲ和IV组,IV组苏醒期兴奋躁动的发生率高于其他各组。麻醉效果达优者以IV组最少。术后下腹痛VAS评分0～2分者Ⅲ组优于其他组。结论异丙酚复合氯诺昔康用于老年患者妇科门诊短小手术的麻醉中不但可获得较为满意的麻醉效果,而且药物不良反应少,对术后下腹痛也表现出更好的镇痛效果,是一种更为有效的配伍方法。

[ Objective ] To explore the effect of Propofol anesthesia with analgesics for middle and old age outpatient operation in gynecology department. [Methods] 80 ASA Ⅰ-Ⅲoutpatients older than 55 years old were randomly divided into four groups. Group I was administrated Fentanyl 1 μg/kg first, 2 mg/kg in Propofol 1 minute. Group Ⅱ was administrated Tramadol 1 mg/kg first, 2 mg/kg in Propofol 1 minute. Group Ⅲ was administrated Lornxicam 0.15 mg/kg first, 2 mg/kg in Propofol 5 minute Group IV was administrated Propofol 2 mg/kg. The speed of intravenous injection of Propopfol was 100 mg/min in all four groups. Induction time, recovery time, dosage of Propofol, HR, BP, SpO2, and side effects were recorded. The anesthesia effects were judged by operation doctors. [Results] Propofol consumption, awaken time in Ⅳ group were more than other groups. The number of patients in group Ⅰ the minimum value of SpO2 in operation was 85%-90% or SpO2〈85%, which were higher than that in the other groups（P 〈0.05）. The number of patients in group Ⅰ and Ⅱ with the tongue fell backwards during anesthesia, the post-anesthesia nausea and vomit were higher than the other groups（ P 〈0.05）. Incidence of post-anesthesia excitement or delirium were more significant than that in the other groups. Moreover the number of patients in group Ⅳ with a good level anesthesia effect was less than that in the other groups. The post-operative hypogastrlc pain of VAS score 0-2 in group Ⅲ were more than others groups. [Conclusions] Propofol combined with Lomoxiacam gives more efficient anesthesia for old outpatient operations in gynecology department, it can not only obtain satisfying anesthesia effect, but also decrease adverse effects and obtain approving depression effects to the post-operative hypogastric pain.