丙泊酚注射痛指导无痛人流术后镇痛模式的临床观察

Clinical Observation of Postoperative Analgesia Mode Guided by Injection Pain of Propofol in Painless Abortion

[目的]探讨用丙泊酚注射痛指导无痛人流术后镇痛模式的可行性.[方法]选择本院2011年1～6月拟行无痛人流的患者1200例,年龄18～42岁,ASAⅠ～Ⅱ级,按照手术先后顺序分为分为三组（Ⅰ、Ⅱ、Ⅲ组）,每组400例.三组均以0.5 mL/s的速率静注1%丙泊酚2 mg/kg,当丙泊酚给药量达1/4时暂停给药,采用语言等级评定量表（VRS）评分法评价丙泊酚注射痛（VRS 1分为发生注射痛,VRS≥2分为中重度注射痛）,之后静注剩余量丙泊酚完成麻醉诱导,Ⅰ组所有病例未予其他特殊处理;Ⅱ、Ⅲ组中VRS≥1分者术中静注舒芬太尼0.2 μg/kg;Ⅲ组中VRS≥2分者术后另给予下腹部理疗辅助镇痛.术后30 min时采用视觉模拟评分法（VAS）评价患者无痛人流术后疼痛程度,VAS评分≥30分为发生术后疼痛.[结果]丙泊酚注射痛发生率Ⅰ组为67%,Ⅱ组为68.5%,Ⅲ组为65%,三组间差异无统计学意义（ P ＞0.05）;术后疼痛发生率Ⅰ组为70%,Ⅱ组为26%,Ⅲ组为11.3%,Ⅱ、Ⅲ组与Ⅰ组比较差异有显著性（ P ＜0.01）,说明依据丙泊酚注射痛给予舒芬太尼能明显减少术后疼痛发生率;Ⅱ组与Ⅲ组比较差异有显著性（ P ＜0.01）,说明依据丙泊酚注射痛程度给予不同术后镇痛模式的有效性.[结论]应用丙泊酚注射痛指导无痛人流术后镇痛的模式是一种可靠的方法.

[Objective] To explore the feasibility of postoperative analgesia mode guided by injection-induced pain of propofol in painless abortion. [Methods] Totally 1200 patients（aged 18~38 years old） with ASA Ⅰ-Ⅱ elective painless a- bortion were chronologically divided into 3 groups（group Ⅰ,Ⅱ andⅢ） with 400 cases in each group. Anesthesia of every group was induced with 2mg/kg 1% propofo[. Propofo[ was withdrawal when the dosage was up to the fourth of total in- duction dose. Verbal rating scale（VRS） was used to assess the pain induced by propofol injection. If VRS was 1 score, injection pain occurred. If VRS was more than 2 scores, middle and severe injection pain occurred. Then the rest part of propofol was injected intravenously for anesthesia induction. All patients in group I were not given other special treat- ment. Those patients（VRS≥1） in group II and Ill were injected with 0.2μg/kg sufentanil during the operation. Those patients（VRS≥2） in group Ⅲ were additionally given abdominal physical therapy for assistant analgesia. Verbal analogue scale（VAS ） was used to evaluate the pain degree after painless abortion. If VAS was more than 30 scores, postoperative pain occurred. [Results] The incidence of the pain induced by propofol injection in group Ⅰ, group Ⅱ and groupⅢ was 67 %, 68. 5 % and 65 % respectively, and there was no significant difference among 3 groups（ P 〉0.05）. The incidence of postoperative pain in group Ⅰ, group Ⅱ and group Ⅲ was 70 %, 26% and 11.3% respectively, and there were signifi- cantly differences between groupⅡ, group Ⅲ and group Ⅰ（ P 〈0.01）. This suggested that sufentanil given according to the degree of injection pain obviously redufed the incidence of postoperative pain, and there was significant difference between group Ⅱ and group Ⅲ （ P 〈0.01 ）. Different postoperative analgesia mode guided by the degree of injection pain was feasible. [Conclusion] Postoperative analgesia mode guided by the pain of propcffol injection in painless abortion is a reliable method.