纳布啡与舒芬太尼无痛人工流产术的麻醉效果比较

Comparison of Anesthetic Effect Between Nabulphine and Sufentanil in Painless Induced Abortion

目的比较纳布啡与舒芬太尼在妇科门诊无痛人工流产术中的麻醉效果。方法选取2018年5月至2018年11月在郑州大学第二附属医院行妇科人流手术的患者(ASAⅠ级或Ⅱ级)90例,使用随机数字表法均分为纳布啡组(N组)和舒芬太尼组(S组),每组45例。手术开始前N组和S组患者分别静脉注射纳布啡0.1 mg/kg及舒芬太尼0.1μg/kg,复合丙泊酚麻醉。记录两组患者丙泊酚推注前5 min(T_(0))、睫毛反射消失时(T_(1))、手术开始时(T_(2))、扩宫颈时(T_(3))、手术结束时(T_(4))、麻醉苏醒时(T_(5))血流动力学指标MAP、HR及SpO_(2);观察两组丙泊酚用量、手术时间及麻醉苏醒时间(退出宫腔镜至患者能自主睁眼的时间);记录两组患者术中及麻醉恢复期的不良反应发生情况。结果在T_(2)、T_(3)时点N组MAP和HR显著低于S组,差异有统计学意义(P<0.05),SpO_(2)显著高于S组,差异有统计学意义(P<0.05),且N组丙泊酚用量少,差异有统计学意义(P<0.05),两组患者手术时间及苏醒时间差异无统计学意义,差异无统计学意义(P>0.05);N组术中严重体动反应、恶心呕吐及呼吸抑制发病率显著降低,差异有统计学意义(P<0.05),术中低血压,窦性心动过缓及疼痛的发生率两组比较,差异无统计学意义(P>0.05)。结论使用合适剂量的纳布啡复合丙泊酚在妇科门诊无痛人流手术中麻醉效果显著,丙泊酚用量减少,不良反应减轻且术中血流动力学波动轻微。

Objective To compare the anesthetic effect of nabulphine and sufentanil in painless induced abortion in gynecological clinic.Methods A total of 90 cases of patients with ASAⅠorⅡlevel who were going to undergo elective gynecological abortion surgery in the second affiliated hospital of zhengzhou university from May 2018 to November 2018 were choosed,according the random number table method,the patients were divided into nabulphine group(N group)and sufentanil group(S group),with 45 cases in each group.Before the operation,patients in N group and S group were injected with nabulphine 0.1 mg/kg and sufentanil 0.1μg/kg intravenously,respectively,and combined with propofol for anesthesia.Hemodynamic indicators MAP,HR and SpO_(2) were recorded 5min before propofol injection(T_(0)),when eyelashes reflex disappeared(T_(1)),at the beginning of operation(T_(2)),at the dilation of cervix(T_(3)),at the end of operation(T_(4)),and at the awakening of anesthesia(T_(5)).The dosage of propofol,operation time and anesthesia recovery time(the time from withdrawal of hysteroscopy to the time when the patients could open their eyes independently),and the adverse reactions during the operation and the recovery period of anesthesia were observed and recorded in two groups.Results Compared with the S group,MAP and HR in the N group at time points T_(2) and T_(3) were significantly lower than those in the S group(P<0.05),SpO_(2) was significantly higher than that in the S group(P<0.05),and the amount of propofol in the N group was less(P<0.05).There were no statistically significant differences in operation time and wake time between the two groups(P>0.05).The incidence of severe intraoperative kinesthetic reactions,nausea and vomiting and respiratory depression were significantly reduced in N group(P<0.05),and the incidence of intraoperative hypotension,sinus bradycardia and pain were not statistically different between the two groups.Conclusion The application of appropriate dosage of nbuphine combined with propofol in painless abortion in gynecological clinic has an accurate anesthetic effect,with reduced dosage of propofol,reduced adverse reactions and slight intraoperative hemodynamic fluctuations.