丙泊酚静脉复合麻醉在人工流产手术中的临床观察

Clinical Observation of Propofol Balanced Anesthesia for Induced Abortion

目的:将布托啡诺、氟比洛芬酯、芬太尼在分别与丙泊酚复合用于人工流产手术的麻醉,并与单纯丙泊酚麻醉进行比较,寻找适宜于人工流产麻醉的安全可行方法。方法:选择自愿要求行无痛人工流产的早孕妇女80例,随机分为4组,每组20例。Ⅰ组单纯丙泊酚组,Ⅱ组布托啡诺组,Ⅲ组氟比洛芬酯组,Ⅳ组芬太尼组。观察各组术前静注丙泊酚1 min和2 min后和术毕时孕妇的BP、HR、RR、SpO2,同时观察各组麻醉效果、手术时间、手术后清醒时间、丙泊酚使用总量和追加用量、清醒后1 min的VAS评分以及各组术中呼吸抑制、呛咳、呕吐等并发症。结果:Ⅱ、Ⅲ、Ⅳ组麻醉效果分级为优的例数要显著高于I组(P<0.05),清醒后1 min VAS评分,Ⅱ、Ⅲ、Ⅳ组与Ⅰ组比较均显著降低(P<0.01)。布托啡诺与丙泊酚复合麻醉,增加丙泊酚对心肌的抑制作用,在静注丙泊酚后1、2 min及术毕时的HR与术前比较有显著减慢(P<0.01)。与单纯丙泊酚及氟比洛芬酯组比较布托啡诺组12、min时对RR减慢影响均有显著差异(P<0.01),与芬太尼组比较则无显著性差异(P>0.05),至术毕时各组RR已基本恢复术前水平(P>0.05)。结论:无痛人工流产麻醉复合用药可强化丙泊酚的镇痛作用,提高麻醉效果优良率,减轻注射痛,不延长清醒时间;布托啡诺和芬太尼复合丙泊酚麻醉,强化丙泊酚镇痛效果,减少丙泊酚用量,但不同程度引发心率减慢、呼吸抑制和眩晕;氟比洛芬酯复合丙泊酚麻醉,在不减少丙泊酚用量的前提下可产生良好的镇痛作用,提高麻醉效果而无呼吸循环抑制等副作用,大大提高人工流产手术静脉麻醉的安全性,是较理想的人工流产手术静脉麻醉方法。

Objective： To observe the effect of propofol combined with butorphanol, flurbiprofen axeti or fentany, to elect a good method for abortion anesthesia. Methods： To elect eighty ASA Ⅰ -Ⅱerly pregmant women voluntarily claimed to do induced abortion on vein anesthesia were randomly divided into 4 groups. Group Ⅰ（ n = 20）, simple propofol, was administrated 5 ml with nomal sodium first, after 10 minutes with 2 mg/kg propofol, Group Ⅱ （n = 20）, butorphanol group, was administrated with 1 mg butorphanol attenuated to 5 ml use nomal sodium first, after 10 minutes with 2 mg/kg propofol. Group Ⅲ （n = 20）, flurbiprofen axetil group, was ad- ministrated flurbiprofen axetil 50 mg first, after 10 minutes 2 mg/kg propofol. Group Ⅳ （ n = 20 ）, fentany group, was administrated fentany 100 ug attenuated to 5 ml as group Ⅱ first, after 10 min utes propofol 2 mg/ kg. The speed of intravenous injection of propofol was 100 mg/min in all groups. To view BP, HR, RR, SpO2 before operation and after 1 min, 2 rain of intravenous injection of propofol, anesthesia effect（was judged by opera- tion doctors）, operation and recovery time, propofol dosage, boost dosage, 1 min VAS（visual analogue scale）affter operation, pain for injection, respirat depression in all groups, side effect were recorded as vomit and bucking, bradycardia, etc. To do statistical treatment of all the result to strive at butorphanol may be used in induced abortion or not. Results： The number of patients showed a good level anesthesia effect in group Ⅱ, group Ⅲ, group was higher than group Ⅰ （P 〈 0.05）. The 1 min postoperative hypogastric pain of VAS score was lower also （P 〈 0.01 ）. Cardiac muscle may be inhibed severity when propofol combined, with butorphanol. The HR are lower after intravenous injection at 1 min and 2 min thsn that at preoperative time in group Ⅱ . It showed significant difference at group I and group m with group II in RR, but it is recovered at postoprative（P 〉0.05）. Conclusion： First the analgesic effect is fortified and the best rate is elevated with propofol balanced anesthesia, pain for injection is decreased＇ and recovery time isn＇ t extended. Second, butorphanol combined with propofol for induced abortion anesthesia can increase anesthetic efficacy and decrease propofol consumption. But it can cause heart rate decreased, respiratory depression on different degree and dinus. Thired, the effect of propofol combined with flurbiprofen axetil for abortion analgesic is well, no respiratory and circulatory depression, side effect don＇ t incressed. It＇s a safety and efficacy good mathod.