不同生育史患者无痛人流术中所需丙泊酚靶浓度差异性观察

Observation of propofol target concentration in painless induced abortion for patients with different fertility histories

目的探讨在无痛人流的麻醉过程中,丙泊酚效应室靶控输注复合芬太尼用于不同生育史患者的所需丙泊酚靶浓度的差异性。方法按不同生育史将自愿接受无痛人流手术的患者分为初孕流产组、有无痛人流史组及有经阴分娩史组3组,麻醉诱导前均予2.5单位缩宫素缓慢静滴,均按照芬太尼1μg/kg复合丙泊酚效应室浓度4.0mg/L的剂量给药,观察患者意识状态。若患者意识未消失,则按照0.5mg/L的效应室浓度梯度增加丙泊酚用量。待患者呼之不应、睫毛反射消失后,维持该丙泊酚靶浓度持续靶控泵注,并开始实施手术,所有手术均由同一医生进行操作。若术中患者出现体动,则继续按照0.5mg/L的效应室浓度梯度增加丙泊酚用量,直到麻醉深度满足手术操作需求,记录丙泊酚最终效应室浓度。清宫完成后停止丙泊酚泵注。记录患者在入室时、手术开始时、手术结束时、患者睁眼时的平均动脉压、心率、血氧饱和度数值,以及手术时长、从手术结束到患者睁眼所需时间、从手术结束到患者清醒所需时间以及患者清醒和睁眼时的VAS评分,记录丙泊酚最终效应室浓度,观察各组患者术中及术后不良反应发生情况。结果在芬太尼用量为1μg/kg的情况下,A,B,C 3组患者丙泊酚效应室靶控浓度分别为(4.56±0.60)mg/L,(4.93±0.68)mg/L,(4.22±0.29)mg/L,3组比较,差异有显著性(P<0.05)。结论不同生育史患者在人工流产术中所需丙泊酚效应室浓度不同,其中有流产史的患者所需丙泊酚用药量最大,初孕流产者次之,有经阴分娩史的患者用药量最小。

Objective To explore the difference in the dose of propofol required for target-controlled infusion of effect-site of propofol combined with fentanyl for patients with different reproductive history during anesthesia with painless abortion.Methods Based on different fertility histories,patients who voluntarily received painless abortion surgery are divided into three groups:first-trimester abortion group,painless abortion history group,and transvaginal delivery history group.Before anesthesia induction,they are all given 2.5 units of oxytocin slowly and intravenously,and all are administered at a dose of fentanyl 1μg/kg compound propofol effect-site concentration 4.0 mg/L,then observe the patient’s consciousness.If the patient’s consciousness does not disappear,increase the propofol dosage according to the effect-site concentration gradient of 0.5 mg/L.After the patient is unresponsive and the eyelash reflex disappears,maintain the target concentration of propofol,continue the target-controlled pumping,and start the operation.All operations are performed by the same gynecologist.If the patient has body movement,continue to increase the propofol dosage according to the effect-site concentration gradient of 0.5 mg/L until the depth of anesthesia meets the requirements of the surgical operation,and record the final effect-site concentration of propofol.Stop the propofol pumping after the uterine curettageis completed.Record the mean arterial pressure,heart rate,and blood oxygen saturation valueof the patient at the time of admission,at the beginning of the operation,at the end of the operation,and at the time of the patient’s eye opening,and the length of the operation,the time from the end of the operation to the patient’s eye opening,the time from the end of the operation to the patient’s awake and the patient’s awake and eye opening VAS score.Record the final effect-site concentration of propofol,and observe the adverse reactions during and after the operation of each group.Results With a dosage of fentanyl of 1μg/kg,three target control concentration of propofol effect chamber in patients with A,B,C group were(4.56±0.60)mg/L,(4.93±0.68)mg/L,(4.22±0.29)mg/L,respectively,and the difference between the three groups was statistically significant.Conclusion Patients with different fertility histories require different concentrations of propofol effect during artificial abortion.Patients with abortion history require the highest dose of propofol,followed by those who have a first trimester abortion,and those with vaginal delivery history have the least amount.