不同镇痛方法用于人工流产术的效果比较

目的：观察多模式镇痛方式用于无痛人工流产术的临床疗效。方法选择ASAⅠ～Ⅱ级早孕自愿行无痛人工流产者150例，所有患者无手术禁忌证，数字表法随机分为五组，每组30例，空白对照组（S组）：未使用任何镇痛措施，术前静脉注射0．9％氯化钠注射液2 mL；芬太尼组（F组）：术前静脉注射芬太尼1μg/kg；帕瑞昔布组（ P组）：术前静脉注射帕瑞昔布钠40 mg。以上三组均在注射药物后行无痛人流麻醉。神经阻滞组（ N组）：实施无痛人流麻醉后待患者入睡后行子宫颈神经阻滞，注射1％利多卡因2 mL。多模式镇痛组（ M组）：静脉注射帕瑞昔布钠40 mg、芬太尼1μg/kg，然后实施方法同N组。观察各组患者：手术时间、麻醉起效时间、恢复时间、准确定向时间和丙泊酚追加用量；人工流产综合征发生率，宫缩痛发生率，手术后10 min、30 min、1 h、6 h疼痛评分；不良反应；术后24 h患者对镇痛效果的满意度评分。结果 S组、F组、P组、N组、M组的丙泊酚追加用量分别为（78．45±20．36） mg、（15．55±12．33） mg、（16．75±13．13） mg、（14.55±10．25）mg、（9．35±8．27）mg；宫缩痛发生率分别为30％、10％、10％、10％、0。与M组比较，其它四组丙泊酚追加用量均显著增加、宫缩痛发生率显著增多（ t＝3．05、1．82、1．84、1．78，χ2＝72．1、68．2、68．2、68.2，均P＜0．05）。 S组术后10 min、30 min、1 h、6 h疼痛评分分别为（6．6±1．5）分、（5．6±1．4）分、（4．6±1．1）分、（3．6±1.4）分；F组疼痛评分分别为（5．1±1．5）分、（4．3±1．1）分、（3．1±0．9）分、（2．8±0．8）分；P组疼痛评分分别为（4.6±1．5）分、（4．2±0．9）分、（2．9±0．8）分、（2．7±0．6）分；N组疼痛评分分别为（4．5±1．5）分、（4．1±0．8）分、（2．9±0．8）分、（2．6±0．5）分；M

Comparison of the effects of different analgesia methods for artificial abortion

Objective To observe the clinical effect of multimodal analgesia for painless artificial abortion . Methods 150 cases of ASA Ⅰ-Ⅱ pregnancy received painless artificial abortion operation ,no contraindication for all patients,were randomly divided into the five groups ,30 cases in each group,the blank control group （group S）：do not use any analgesia measure ,intravenous injection of 0.9% sodium chloride 2mL preoperation;the fentanyl group （ F group ） ：intravenous injection of fentanyl 1μg/kg preoperation ;the parecoxib group （ group P ） ：intravenous injection of parecoxib sodium 40mg preoperation.The patients were given painless artificial abortion after injection the above drugs.Nerve block group （ N group）：the implementation of painless induced abortion operation after sleep in patients with the cervical nerve block ,injection of 1%lidocaine 2 mL.Multimodal analgesia group （group M）：intra-venous injection of parecoxib sodium 40mg,fentanyl 1μg/kg,then the implementation method the same as N group . The operation time,anesthesia onset time,recovery time,time of accurate orientation and additional dosage of propo-fol;incidence rate of artificial abortion syndrome ,the incidence rate of uterine contraction pain ,10min,30min,1h,6h pain scores after operation; adverse reaction;satisfaction score of analgesic effect postoperative 24h were observed. Results The additional dosage of propofol in the group S ,group F,group P,group N and group M were （78.45 ± 20.36）mg,（15.55 ±12.33）mg,（16.75 ±13.13）mg,（14.55 ±10.25）mg,（9.35 ±8.27）mg.The incidence rates of uterine contraction pain in the group S ,group F,group P,group N and group M were 30%,10%,10%,10%,0. Compared with group M ,the additional dosage of propofol and incidence rate of uterine contraction pain in the other four groups were significantly increased （t=3.05,1.82,1.84,1.78,χ2 =72.1,68.2,68.2,68.2,all P〈0.05）. Pain scores after operation 10min,30min,1h,6h in the group S were （6.6 ±1.5）points,?