利多卡因宫颈旁阻滞联合丙泊酚静脉全麻在人工流产术中的应用

Application of paracervical block with lidocaine combined with intravenous propofol anesthesia in induced abortion

目的探讨利多卡因宫颈旁阻滞联合丙泊酚静脉麻醉用于人工流产术的有效性与安全性。方法选择自愿接受无痛人工流产术的未产妇90例,随机分为3组,每组30例。所有患者均予丙泊酚2.5 mg·kg^-1静脉注射,P组仅予丙泊酚麻醉,PD组在丙泊酚给药前10 min静脉注射地佐辛5 mg,PL组于扩张宫颈前宫颈管3、6、9、12点的黏膜下局部注射1%利多卡因2 mL。记录手术时间、麻醉起效时间、丙泊酚用量、苏醒时间、生命体征、体动和不良反应发生情况。结果与P组比较,PD组和PL组扩宫颈时、吸宫时的平均动脉压(MAP)和心率(HR)、丙泊酚用量、术中体动次数和评分、术毕30 min下腹疼痛VAS评分均降低(P <0.05),PD组苏醒时间延长(P <0.05),PL组苏醒时间缩短(P <0.05),呼吸抑制发生率下降(P <0.05)。与PD组比较,PL组扩宫颈时的MAP和HR、术中体动次数和评分、下腹疼痛VAS评分降低(P <0.05)。PD组呼吸抑制、恶心呕吐和头晕发生率高于其他两组(P <0.05)。结论利多卡因宫颈旁阻滞联合丙泊酚静脉麻醉用于人工流产术安全有效,镇痛效果好,不良反应少。

AIM To evaluate the effects and safety of paracervical block with lidocaine combined with intravenous propofol anesthesia for induced abortion. METHODS Ninty pregnancy nullipara, undergoing painless induced abortion were randomly divided into three groups(n = 30). All patients were anesthetized by intravenous injection propofol 2.5 mg· kg^-1, while dezocine 5 mg was administrated intravenously 10 minutes before propofol administration in group PD, and 1% lidocaine 2 mL was injected into submucosal tissue of the cervix respectively at the point of 3, 6, 9, 12 o’clock before cervical dilatation in the group PL. The operation time, onset time of anesthesia, propofol dosage, awakening time, MAP, HR, SpO2, body movement, and adverse reactions(respiratory depression, intraoperative awareness, nausea, vomiting, and dizzy) were recorded. RESULTS Compared with the group P, MAP and HR at time of cervical dilatation and uterine aspiration, propofol dosage, incidence and degree of body movement, and VAS pain scores in lower abdomen 30 min after operation were significantly decreased in the group PD and group PL(P < 0.05), while awakening time significantly increased in the group PD(P < 0.05), and awakening time and the incidence of respiratory depression significantly decreased in the group PL(P < 0.05). Compared with the group PD, MAP and HR at time of cervical dilatation, incidence and degree of body movement, and VAS pain scores in lower abdomen were significantly decreased in the group PL(P < 0.05). The incidence of respiratory depression, dizzy, nausea and vomiting were significantly increased in the group PD than the other two groups(P < 0.05). CONCLUSION Paracervical block with lidocaine combined with intravenous propofol anesthesia is safe and effective for induced abortions while providing a better analgesic effect and a lower incidence of adverse reaction.