小剂量舒芬太尼复合丙泊酚用于无痛人流的临床研究

Clinical Research of Low-dose Sufentanil Combined with Propofol on Painless Abortion Surgery

目的评价小剂量舒芬太尼复合丙泊酚对无痛人流患者围术期的影响。方法将2015年10月-2016年10月在我院进行无痛人工流产的患者60例纳入研究,采用计算机随机分组,分为小剂量舒芬太尼+丙泊酚组(A组)和丙泊酚组(B组),每组30例。A组患者术前缓慢静脉注射舒芬太尼0.1μg/kg,2~3 min后缓慢静脉注射丙泊酚2 mg/kg;B组患者术前缓慢静脉注射同体积生理盐水,2~3 min后缓慢静脉注射丙泊酚2 mg/kg。记录患者入室后静息5 min(T0,基础值)、手术开始时(T1)、扩张宫颈或刮宫时(T2)、手术结束时(T3)HR、MAP、Sp O2。记录丙泊酚的总剂量、意识恢复时间、定向力恢复时间、术中呼吸抑制和术后宫缩痛的发生率及恶心呕吐等不良反应。结果手术开始时(T1),B组患者MAP较前下降,HR较前升高(P<0.05);当术中进行扩张宫颈或刮宫等操作时(T2),B组患者BP明显上升,HR增快(P<0.05),手术结束时恢复术前水平;A组患者丙泊酚用量及术中追加次数均少于B组患者(P<0.05);A组患者低血压发生率低于B组(P<0.05);A组患者出院时VAS疼痛评分要显著低于B组(P<0.05)。结论小剂量舒芬太尼复合丙泊酚用于无痛人流与单用丙泊酚相比,丙泊酚用量减少,镇痛显著增强,术后下腹痛发生率降低,不良反应未见明显增加,是安全而有效的方法。

Objective To evaluate the effects of low - dose sufentanil and propofol on perioperative outcomes of painless abortion surgery. Methods Sixty female patients undergoing painless induced abortion between October 2015 and October 2016 Were randomly divided into two groups： group A was received slow injection of sufentanil 0.1 ug/kg before sur- gery, followed by intravenous injection of propofol 2 mg/kg 2 - 3 minutes later and group B was administered the same volume of normal saline, followed by intravenous injection of propofol 2 mg/kg 2 - 3 minutes later. The effects on HR, BP, SpO2 by 5 minutes after entering operation room （T0） , surgery beginning （T1） , cervix dilatation or curettage （T2） , surgery ending （ T3 ） were recorded. Total propofol dosage, recovery time of consciousness and orientation and side effects including the inci- dence of intraoperative respiratory depression, postoperative uterus systole, nausea and vomiting were recorded. Results MAP dropped and HR increased at surgery beginning （T1） compared to baseline（To） in group B （P 〈0. 05）. BP and HR both increased at cervix dilatation or curettage （T2） compared to baseline （TO） in group B （P 〈 0. 05 ） and returned to base- line after surgery. The propofol dose and frequency of adding propofol significantly decreased in group A （ P 〈 0. 05 ）. The in- cidence of low MAP was significantly reduced in group A （ P 〈 0. 05 ）. The VAS pain score was significantly lower in group A （P 〈 0. 05 ）. Conclusion Compared with sole propofol administration, intravenous injection of propofol combined with low - dose sufentanil help the reduction of the total propofpol dosage and postoperative hypogastralgia, obvious improvement of analgesia, and decrease of rate of side effects, so it is a safe and effective therapy.