丙泊酚复合芬太尼、咪达唑仑用于无痛输卵管结扎术的临床观察

目的探讨丙泊酚复合芬太尼、咪达唑仑用于无痛输卵管结扎术的镇痛效果及不良反应。方法将受术者随机分为三组,每组60例。A组为普鲁卡因局部麻醉组,使用0.5%普鲁卡因行腹部切口部位局部麻醉,剂量40～60ml;B组为氯胺酮复合丙泊酚静脉全麻组,用药剂量:氯胺酮1mg/kg静脉注射后,丙泊酚1.5mg/kg静注维持麻醉;C组为丙泊酚复合芬太尼、咪达唑仑静脉全麻组,用药剂量:咪达唑仑2～4mg静注后,静注复合液15～20ml,复合液为丙泊40ml(400mg)+芬太尼4ml(0.2mg)+麻黄碱1ml(30mg),随后根据受术者情况利用余下的复合液维持麻醉。结果A组完全无痛率28.3%,其中镇痛效果Ⅰ级为8.3%,Ⅱ级为20%。B组完全无痛率100%,其中镇痛效果Ⅰ级为16.7%,Ⅱ级为83.3%,本组有明显的呼吸抑制、循环系统改变及精神症状等不良反应,术后苏醒时间较长;C组完全无痛率100%,镇痛效果全部为Ⅰ级,无明显不良反应,术后苏醒时间短。三组比较:三组之间镇痛效果相比较有显著性差异(p<0.01);B组与C组之间不良反应及苏醒时间相比较有明显差异(p<0.05)。结论丙泊酚复合芬太尼、咪达唑仑用于无痛卵管结扎术,麻醉镇痛效果好、不良反应少、苏醒时间短,是一种安全、有效、理想的静脉麻醉方法。

CLINICAL OBSERVATION OF TUBAL LIGATION ANALGESIA WITH PROPOFOL COMBINED WITH FENTANYL AND MIDAZOLAM

Objective To discuss propofol combined with fentanyl and midazalam in the analgesic effect and the adverse reaction in tubal ligation analgesia. Methods Patients underwent tubal ligation were randomly divided into three groups, 60 patients each group.Procaine local anesthesia group (A group, using 0.5% procain 40~60 ml); Katamine combined with propofol intravenous anesthesia group (B group ,after injecting ketamine 1 mg/kg intravenous, propofol 1.5 ml/kg maintain intravenous anesthesia); Propofol combined with fentanyl and midazolam intravenous anesthesia group (C group ,after injecting midazolam 2~4 mg, compound 15~20 ml intravenous anesthetic, the compound was composed of propofol 40 ml(400 mg) combined with fentanyl 4 ml(0.2 mg) and ephendrini 1ml(30 mg). Results In A group the rate of analgesia is 28.3%; in B group the rate of analgesia is 100% , but the respiratory depression、the change of circle system and psychological symptom significantly occur in patients; in C group the rate of analgesia is 100%,and the adverse reaction did not occur in patients. The difference of the analgesic effect of the three groups was significant(p<0.01). The difference of the adverse reaction and the revival time of between B group and C group was significant(p<0.05). Conclusion Usiung propofol combined with fentanyl and midazalam in the tubal ligation analgesia was resulted in well effect and reduced the adverse reaction and revival time.