不同剂量高乌甲素联合丙泊酚用于无痛人流术的临床观察

The clinical observation of the different doses of lappaconitine combined to propofol anesthesia for abortion

目的:观察不同剂量高乌甲素联合丙泊酚用于无痛人工流产术麻醉的有效性和安全性。方法:80例人工流产患者,以随机数字表法均分为Sf、LA_1、LA_2、LA_3四组,Sf组静注舒芬太尼0.1μg/kg,其他各组分别静注高乌甲素0.06mg/kg、0.1mg/kg、0.15mg/kg,3min后静注丙泊酚2mg/kg,睫毛反射消失入睡后手术,术中有体动、皱眉时单次静注丙泊酚30~50mg维持麻醉。记录麻醉前(T_1)、手术开始即刻(T_2)、吸宫操作时(T_3)、手术结束即刻(T_4)、清醒时(T5)各时点MAP、SpO_2、HR、AAI,记录丙泊酚总用量、手术时间、清醒时间,记录术中呼吸抑制、心律失常、呃逆、体动等发生情况及术后头晕、恶心、呕吐等不良反应,记录清醒30min VAS评分。结果:于T_1比较四组MAP在T_2~T_4均明显降低;T_2时Sf组较其他组明显降低,T_3、T_4时Sf组、LA_1组明显低于LA_2、LA_3组。与T_1比较Sf组在T_2~T_4时HR明显降低,LA_1组、LA_2组在T_3、T_4明显降低,LA_3组在T_3、T_4明显升高;Sf组在T_2时较其他组明显降低,LA_3组在T_3、T_4明显高于其他组;与T_1比较Sf、LA_1、LA_3组在T_2、T_3时SpO_2明显降低,LA_2组在T_2明显降低,T_3时其他组明显低于LA_2组;与T_1比较四组在T_2~T_4AAI值均明显降低,LA_1组在T_2~T_4高于其他组,差异有统计学意义。丙泊酚总用量Sf、LA_1组明显多于LA_2、LA_3两组,LA_1组明显多于Sf组。清醒时间Sf组、LA_1组明显长于LA_2、LA_3两组。清醒后30min VAS评分LA_1组明显高于其他组。呼吸抑制、头晕、嗜睡Sf、LA_1组发生率明显高于其他两组,LA_3组心律失常、呃逆发生率明显高于其他三组,呼吸抑制明显高于LA_2组;LA_1组体动发生率明显高于其他三组。结论:0.1mg/kg高乌甲素联合2.0mg/kg丙泊酚用于无痛人工流产术是安全有效的。

Objective：to observe the effectiveness and safety of different doses of lappaconitine combined to propofol anesthesia for abortion. Methods： 80 patients with induced abortion, random number table method were divided intoSf, LAI, LA2, LA3 four groups, Group Sf intravenous sufentanil intravenous injection of 0.1μg/kg, Other groups were injected separately lappaconitine 0.06mg/kg, 0.1mg/kg, 0.15mg/kg, 3 minutes after the intravenous injection of propofol 2mg/kg, patients with loss of eyelash reflex sleep after surgery, intraoperative body movement, frowning a single intravenous injection of propofol to maintain anesthesia in 30 - 50mg. Records of patients before anesthesia （T1）, immediately after the beginning of surgery （T2）, suction palace operation （T3）, at the end of surgery （T4）, awake （T5） at MAP, SpO2, the HR, AAI, record the total amount of propofol, the operation time, recovery time, intraoperative respiratory depression, heart rhythm arrhythmia, hiccup, physical activity and the incidence of postoperative nausea, dizziness, vomiting and other adverse reactions, 30 minute VAS score was recorded in awake. Results：Compared with T1,MAP in the four groups weie significantly lower t from T2 to T4, the Sf group was significantly lower than others inT2, Sf and LA1 were significantly lower than LA2 and LA3 at T2 and T3; Compared with T1,In the Sf group, the HR decreased significantly at T2-T4, In LA~ and LA2 were significantly decreased at T3 and T4, In LA3 group were significantly higherat at T3 and T4,in Sf group was significantly lower than others at T2, in LA3 group were significantly higher than others atT3 and T4; Compared with Ti,in Sf, LA1, LA3 group SpO2 decreased significantly at T2 and T3, In LA2 group, SpO2 was significantly lower at T2, others were significantly lower than LA2 at T3;Compared with T1, in the four groups AAI was significantly decreased fromT2 to T4, In LA1 group, AAI were higher than others fromT2 to T4, Difference was statistically significant. The total dosage of propofol, LA1, LA2 group were more than Sf, LA3 two groups, LA1 group was significantly more than Sf group. Awake time Sf group, LA1 group was longer than LA2, LA3 two groups. After 30min VAS score, the LA1 score was significantly higher than other groups. Respiratory depression, dizziness, drowsiness, Sf LA1 group was significantly higher than the other two groups, LA3 group of arrhythmia, Hiccup incidence was significantly higher than the other three groups, respiratory inhibition was significantly higher than LA2 group; LA1 group of body movement incidence was significantly higher than the other three groups. Conclusion lappaconitine of 0.1mg/kg combined to propofol of 2.0mg/kg is an effective and safe anesthesia for abortion.