围术期容量管理对早期稽留流产无痛人工流产术影响

Influence of perioperative blood volume management on the effect of painless induced abortion of patients with early missed abortion

目的:探讨围术期容量管理对早期稽留流产患者无痛人工流产术后并发症的预防。方法:选取2020年11月-2021年11月于本院行无痛人工流产术的稽留流产患者158例,随机数字表法分为观察组和对照组各79例。两组均采用瑞芬太尼注射液+丙泊酚行麻醉,观察组于麻醉前行预扩容处理。观察两组手术时间、术中出血量和丙泊酚用量;麻醉前后各时点血流动力学指标及视觉模拟疼痛(VAS)评分;术前及术后3个月性激素指标变化;不良反应和并发症发生情况。结果:观察组丙泊酚用量少于对照组,麻醉后5min MAP高于对照组,麻醉后1min、5min、10min HR均低于对照组;术后6h、12h、24h VAS评分均低于同时点对照组;术后3个月血清黄体生成素、卵泡刺激素水平均高于对照组,雌二醇、抗苗勒氏管激素水平均低于对照组;术后血压下降(15.2%)、心率增快(20.3%)、头晕(10.1%)、恶心呕吐(0)发生率均低于对照组(46.8%、54.4%、38.0%、10.1%);术后3个月并发症总发生率(5.1%)低于对照组(20.3%)(均P<0.05)。结论:早期稽留流产患者行无痛人工流产术围术期采用麻醉管理,可有效减少麻醉药物用量,稳定血流动力学,减轻手术疼痛和生殖功能损害,降低不良反应和并发症发生率。

Objective: To explore the prevention of postoperative complications of the perioperative blood volume management for patients with early missed abortion after painless induced abortion. Methods: 158 patients with early missed abortion who wanted painless induced abortion were selected and were randomly divided into observation group(n=79) and control group(n=79) by random number table method from November 2020 to November 2021. The patients in the two groups were anesthetized with remifentanil injection combined with propofol, and the patients in the observation group were pretreated with blood volume expansion before anesthesia additionally. The operation time, the intraoperative blood loss, the propofol dosage, the levels of hemodynamic indexes and the pain score of visual analogue scale(VAS) at different time point before and after anesthesia, the changes of the levels of sex hormone indexes before and 3 months after operation, and the occurrences of adverse reactions and complications of the patients in the two groups were observed. Results: The propofol dosage of the patients in the observation group was significantly lower than that of the patients in the control group, the MAP value of the patients in the observation group at 5min after anesthesia was significantly higher than that of the patients in the control group, and the HR value of the patients in the observation group at 1min, 5min, or 10min after anesthesia was significantly lower than that of the patients in the control group. The VAS scores of the patients in the observation group at 6h, 12h, and 24h after operation were significantly lower than those of the patients in the control group. The levels of luteinizing hormone and follicle stimulating hormone of the patients in the observation group at 3 months after operation were significantly higher than those of the patients in the control group, while the levels of the estradiol and anti-Muller’s hormone of the patients in the observation group were significantly lower. The incidences of the decreased blood pressure(15.2%), the increased heart(20.3%), the dizziness(10.1%), the nausea and vomiting(0) of the patients in the observation group were significantly lower than those(46.8%,54.4%,38.0%,and 10.1%)of the patients in the control group.In 3months after operation,the total complication rate(5.1%)of the patients in the observation group was significantly lower than that(20.3%)of the patients in the control group(all P<0.05).Conclusion:The perioperative blood volume management of painless induced abortion of the patients with early missed abortion can effectively reduce the dosage of anesthetics,stabilize the hemodynamics,reduce the operative pain and the reproductive function damage of the patients,and can decrease the incidences of adverse reactions and complications.