静脉麻醉用于宫腔镜电切术的临床观察

Clinical observation of intravenous anesthesia for hysteroscopic surgery

目的探讨静脉麻醉在宫腔镜电切术中应用的可行性及恰当的药物配伍。方法选择我院2015年1~8月拟行宫腔镜电切术的患者120例,随机分为3组：P组仅静脉注射丙泊酚2 mg/kg,F组先静注芬太尼0.0015 mg/kg,S组则先静注舒芬太尼0.15μg/kg后再静注丙泊酚。观察并记录给药前、麻醉后扩宫颈前、扩宫颈时、术毕时患者的收缩压、舒张压、心率,比较丙泊酚用量和术中需托下颌或辅助呼吸的例数。记录清醒即刻（W_0）、清醒后15 min（W_1）、清醒后30 min（W_2）、1 h（W_3）、2 h（W_4）及6 h（W_5）下腹疼痛的情况（Prince-Henry）。结果扩宫颈时,与P组比较,F组和S组的SBP、DBP、HR均明显降低（P〈0.05）;术毕时,与P组比较,F组和S组的SBP、DBP、HR差异有统计学意义（P〈0.05）,苏醒时间都显著缩短（P〈0.05）,丙泊酚的用量都明显减少（P〈0.05）。与F组比较,S组的丙泊酚用量仍明显减少（P〈0.05）,术中需托下颌或辅助呼吸的患者例数明显减少（P〈0.05）。W_0~W_3时,F组和S组的prince-Henry评分明显降低（P〈0.05）;W_4~W_5时,S组的prince-Henry评分仍明显低于P组（P〈0.05）,而F组则与P组无明显差异（P〉0.05）。结论静脉麻醉可以应用于短时的宫腔镜手术,尤以小剂量的舒芬太尼复合丙泊酚的应用更加安全理想。

Objective To investigate the feasibility of intravenous anesthesia and the proper drug compatibility during hysteroscopic surgery. Methods A total of 120 patients underwent hysteroscopic surgery from January 2015 to August2015 were randomly divided into 3 groups. P group was only injected with propofol（2 mg/kg）, F group was treated with fentanyl（0.0015 mg/kg）, and S group was given sufentanil（0.15 μg/kg） before intravenous injection of propofol. The systolic/diastolic blood pressure and the heart rate were observed and recorded during hysteroscopic surgery. The dosage of propofol and the number of patients needed chin or auxiliary breathing were compared. Lower abdominal pain condition（Prince-Henry） in awake state immediately（W0）, 15 min（W1）, 30 min（W2）, 1 h（W3）,2 h（W4） and 6 h（W5） after awake state were recorded. Results SBP, DBP and HR of F group and S group were obviously lower（P〈0.05） than those of P group during dilated cervix. Compared with P group, SBP, DBP and HR of S group was significantly different（P〈0.05）,and the recovery time and the dosage of propofol of F group and S group decreased obviously（P〈0.05） after operation.Compared with F group, the dosage of propofol and the number of patients needed chin or auxiliary breathing of S group decreased obviously（P〈0.05）. The prince-henry scores of F group and S group were significantly lower（P〈0.05）during W0-W3. The prince-henry score of S group was still significantly lower than that of P group（P〈0.05）, while there was no significant difference between F group and P group（P〉0.05） during W4-W5. Conclusion Intravenous anesthesia can be applied to the short-term hysteroscopic surgery, especially, small dose of sufentanil combined with propofol is more safe and ideal.