右美托咪定与芬太尼用于无痛人工流产麻醉的对比研究

Observation of dexmedetomidine and fentanyl for painless artificial abortion

目的比较右美托咪定与芬太尼用于无痛人工流产麻醉效果及不良反应。方法将2013年1月至2014年2月于浙江省温州市中心医院行无痛人工流产术的116例患者完全随机分为对照组（56例）和观察组（60例）。对照组给予芬太尼注射液和丙泊酚注射液，观察组给予右美托美咪定和丙泊酚注射液。观察2组镇痛效果、术后宫缩痛状况；评估注药前（T0） 、注药后2 min（T1） 、扩阴器置入时（T2） 及扩宫颈时（T3）呼吸、心率、收缩压、脉搏血氧饱和度（SpO2）的改变程度及患者麻醉起效时间、苏醒时间、离院时间及麻醉的不良反应等。结果观察组麻醉效果优为88.3% （53/60），高于对照组的75.0%（42/56）（P＜0.05）；观察组麻醉效果差为1.7% （1/60），低于对照组的10.7%（6/56）（P＜0.05）；观察组心率在T1、T2和T3时点分别为（69±6）、（76±5）和（78±5）次/min，均低于对照组[（76±4），（87±5）和（91±9） 次/min]，观察组收缩压在T1和T2时分别为（93±3）和（95±4）mmHg（1 mmHg=0.133 kPa），均低于对照组[（100±3）和（102±4） mmHg]。观察组SpO2在T1和T2时点分别为（95.8±0.4）%和（98.3±0.6）%，均高于对照组[（93.3±0.8）%和（ 95.7±0.7）%]，差异有统计学意义（P＜0.05）；观察组起效时间、苏醒时间和离院时间分别为（33±3）s、（7.94±0.16）s和（16.1±2.9）min，均少于对照组，观察组丙泊酚用量为（180±7）mg，少于对照组[（200±10）mg]，差异有统计学意义（P＜0.05）。观察组呼吸抑制、恶心呕吐和舌后坠发生率分别为5.0% （3/60）、3.3%（2/60） 和1.7%（1/60）；均低于对照组[14.3%（8/56）、12.5%（7/56）和10.7%（6/56），均P＜0.05]。结论右美托咪定用于无痛人工流产麻醉效果较好，不良反应较低。

ObjectiveTo explore the anesthetic effects and adverse reactions of dexmedetomidine and fentanyl for painless artificial abortion. MethodsTotally 116 cases of painless artificial abortion were randomly selected from January 2013 to February 2014 and were randomly divided into control group （56 cases） and observation group （60 cases） at Wenzhou Central Hospital. The fentanyl （0.02-0.05 mg/kg） and propofol （2-2.5 mg/kg） were administered to the control group; dexmedetomidine （0.7-1 μg/kg） and propofol （1-1.5 mg/kg） were administered to observation group. The analgesic effects and uterine contraction pain status were analyzed. Breathing rate, heart rate, systolic blood pressure, oxygen saturation （SpO2） before infusion （T0）, 2 minutes after injection （T1）, vagina dilator placement （T2）; enlarged cervical （T3）, onset time of anesthesia, recovery time, hospital stay time and anesthetic adverse reactions were analyzed. ResultsThe excellent anesthesia in the observation group was 88.3% （53/60）, which was higher than that in the control group 75.0% （42/56） （P〈0.05）. The poor effects in observation group anesthesia was 1.7% （1/60）, which was lower than that in the control group 10.7% （6/56） （P〈0.05）. Uterine contraction pain grade 3 of the observation group was 1.7% （1/60）, which was lower than that in the control group with 8.9% （5/56） （P〈0.05）. Heart rate at T1, T2 and T3 in the observation group was （69±6） times/min, （76±5） times/min and （78±5） times/min, which was lower than that in the control group [ （76±4） times/min, （87±5） times/min and （91±9） times/min]. SBP in the observation group at T1 and T2 was （93±3） mmHg and （95±4） mmHg, which was lower than those in the control group （100±3） mmHg and （102±4） mmHg. SpO2 in the observation group at T1 and T2 was （95.8±0.4） % and （98.3±0.6） % which was higher than those in the control group（93.3±0.8） % and （95.7±0.7）%; the difference was statistically significant （P〈0.05）. The onset time, recovery time and hospital stay time in the observation group were （34 ± 3） s, （7.9± 0.2） s and （16.1 ± 2.9） min, which were less than those in the control group significantly. The propofol dosage in the observation group was （180± 7） mg, which was less than the control group （200± 10） mg; the difference was statistically significant （P〈0.05）. The incidence rate of respiratory depression, nausea and vomiting and glossoptosis in the observation group were 5.0% （3/60）, 3.3% （2/60） and 1.7% （1/60）, which were lower than those in the control group [14.3% （8/56）, 12.5% （7/56） and 10.7% （6/56） （P〈0.05）]. ConclusionDexmedetomidine is safe and effective for painless artificial abortion.