右美托咪定替代丙泊酚用于无痛流产的临床观察

Clinical observation of dexmetimidine in the replacement of propofol in patients with painless induced abortion

目的探讨右美托咪定替代丙泊酚用于人工流产的可行性及安全性。方法我院门诊ASAⅠ级初孕人工流产172例,年龄16~38岁。随机分为D组和C组,每组86例。D组给予右美托咪定0.8~1.0μg/kg后复合舒芬太尼0.1μg/kg。C组给予丙泊酚注射液2.0~2.5 mg/kg复合舒芬太尼0.1μg/kg。两组必要时可以追加,使患者脑电双频指数(Bispectral index,BIS)值稳定于(55±10)。同时记录两组孕妇从诱导开始到可以手术的时间即诱导时间、心率(HR)、脉搏血氧饱和度(Sp O2)、收缩压(SBP)和舒张压(DBP)、BIS值恢复85以上即时和5 min后的计算力、对两组并发症干预的次数。结果两组孕妇镇静水平达到手术要求,D组的诱导时间、苏醒时间要长于C组,差异有统计学意义(P<0.05);D组的患者BIS值恢复85以上即时计算力高于C组,差异有统计学意义(P<0.05);D组的患者BIS值恢复85以上5 min计算力与C组无差异。结论右美托咪定可替代丙泊酚用于人工流产麻醉,且抑制呼吸作用较轻,但是要注意心率降低的发生。

Objective To investigate the feasibility and safety of dexmetimidine（Dex） in the replacement of propofol in patients with induced abortion. Methods 172 patients aged 16 years to 38 years who were through induced abortion at ASAⅠ grade of primary pregnancy in the outpatient department of our hospital were selected. Patients were randomized into group D and group C with 86 patients in each. Patients in group D were treated with Dex 0.8-1.0 μg/kg at first and a compound of sulfentanyl 0.1 μg/kg. Patients in group C were treated with propofol injection 2.0-2.5 mg/kg compounded with sulfentanyl 0.01 μg/kg. Additional administration was performed when necessary to keep bispectral index（BIS） stable at the value of（55±10）. The induction duration（time from the beginning of induction to the time when operation could be performed）, heart rate（HR）, pulse, blood oxygen saturation（Sp O2）, systolic blood pressure（SBP）and diastolic blood pressure（DBP）, capacity of calculation at the time point and 5 minutes after BIS was back to 85 and more, and the times of intervention to complications in two groups were recorded. Results Sedation status of pregnant women in two groups met the requirements of operation. Induction duration and wake-up time in group D were statistically longer than those in group C. Capacity of calculation at the time point that BIS was back to 85 and more in group D was statistically higher than that in group C. There was no difference of capacity of calculation 5 minutes after BIS was back to 85 and more between group D and C. Conclusion Dex could replace the propofol to be applied in the anaesthesia of induced abortion. Though the respiratory depression effect of Dex was less, it needs to pay attention to the occurrence of low heart rate.