不同剂量地佐辛复合丙泊酚静脉全麻在无痛人流术中的应用

Application of intravenous general anesthesia with different doses of dizocine combined with propofol in painless induced abortion

目的探讨不同剂量地佐辛复合丙泊酚静脉全麻用于无痛人流术中对孕妇苏醒质量和疼痛程度的影响。方法选取2020年1月至2021年4月期间自愿在深圳市平乐骨伤科医院(坪山区中医院)进行无痛人流术的200例孕妇作为研究对象,按照随机数表法分为研究组和对照组各100例。对照组孕妇采用5μg(需稀释)地佐辛联合丙泊酚实施麻醉,研究组孕妇采用3μg(需稀释)地佐辛联合丙泊酚实施麻醉。分别在麻醉诱导前(T0)、丙泊酚给药前(T1)、手术扩宫颈前(T2)、扩宫颈后(T3)、苏醒时(T4)时对比两组孕妇的心率(HR)、平均动脉压(MAP)、收缩压(SBP)、舒张压(DBP);比较两组孕妇术后的苏醒质量(呼吸恢复时间、睁眼时间、拔管时间);采用视觉模拟评分(VAS)比较两组孕妇术后3 h、12 h、24 h的疼痛程度和不良反应发生情况。结果在T0、T1、T2、T3、T4时刻,两组孕妇的HR、MAP、SBP、DBP比较差异均无统计学意义(P>0.05);实施麻醉后,研究组孕妇的呼吸恢复时间、睁眼时间、拔管时间分别为(6.65±1.45)min、(9.39±2.12)min、(11.95±2.57)min,明显短于对照组的(10.75±2.35)min、(13.65±2.05)min、(16.31±2.98)min,差异均有统计学意义(P<0.05);研究组孕妇术后3 h、12 h、24 h的VAS评分分别为(5.85±1.64)分、(3.94±0.99)分、(2.82±0.62)分,明显低于对照组的(7.72±1.58)分、(5.34±0.57)分、(4.43±0.78)分,差异均有统计学意义(P<0.05);研究组孕妇术后的不良反应总发生率为11.0%,明显低于对照组的36.0%,差异有统计学意义(P<0.05)。结论5μg地佐辛联合丙泊酚用于无痛人流术中静脉全麻能提高孕妇苏醒质量,降低术后疼痛程度。

Objective To the effect of intravenous general anesthesia with different doses of dizocine combined with propofol intravenous general anesthesia on the quality of recovery and the degree of pain during painless induced abortion.Methods A total of 200 pregnant women who volunteered to undergo painless abortion in Shenzhen Pingle Orthopedic and Traumatology Hospital(Pingshan District Hospital of Traditional Chinese Medicine)from January 2020 to April 2021 were selected as the research objects.They were randomly divided into the study group and the control group,with 100 cases in each group.The pregnant women in the control group were anesthetized with 5μg(to be diluted)of dizocine combined with propofol,and the pregnant women in the study group were anesthetized with 3μg(to be diluted)of dizocine combined with propofol.The heart rate(HR),mean arterial pressure(MAP),systolic blood pressure(SBP),and diastolic blood pressure(DBP)of the two groups of pregnant women were compared before anesthe-sia induction(T0),before propofol administration(T1),before cervical dilatation(T2),after cervical dilatation(T3)and at the time of awakening(T4).The quality of awakening(respiratory recovery time,eye opening time,extubation time)was compared between the two groups.The degree of pain[Visual Analogue Scale(VAS)score]and the incidence of ad-verse reactions at 3 h,12 h,24 h after operation were also compared.Results At T0,T1,T2,T3,and T4,there was no significant difference in HR,MAP,SBP,and DBP between the two groups(P>0.05).After anesthesia,the respiratory re-covery time,eye opening time,and extubation time in the study group were(6.65±1.45)min,(9.39±2.12)min,and(11.95±2.57)min,which were significantly shorter than(10.75±2.35)min,(13.65±2.05)min,and(16.31±2.98)min in the control group(P<0.05).The VAS scores of the study group were(5.85±1.64)points,(3.94±0.99)points,and(2.82±0.62)points,which were significantly lower than(7.72±1.58)points,(5.34±0.57)points,and(4.43±0.78)points of the control group(P<0.05).The incidence of adverse reactions in the study group was 11.0%,which was significantly lower than 36.0%in the control group(P<0.05).Conclusion 5μg of dizocine combined with propofol for intravenous gener-al anesthesia during painless induced abortion can improve the quality of recovery of pregnant women and reduce the de-gree of postoperative pain,which is worthy of clinical promotion.