丙泊酚注射痛预测人工流产术后镇痛的可行性

目的探讨依据丙泊酚注射痛选择人工流产术后镇痛方法的可行性。方法拟行人工流产术者1500例，随机分为3组，Ⅰ组为对照组；Ⅱ组静脉注射布托啡诺；Ⅲ组静脉注射布托啡诺并下腹部行物理治疗。每组根据疼痛语言等级评定量表（VRS）分为3亚组：VRS=0为a亚组；VRS=1为b亚组；VRS≥2为c亚组。诱导时当丙泊酚给药量达总量1／4时暂停给药，进行VRS评分，之后静脉注射剩余量丙泊酚完成麻醉诱导。术后30min时采用VAS评分。记录VRS、VAS、术前及术后的MAP、HR。结果术后疼痛发生率Ⅱ、Ⅲ组低于Ⅰ组（P〈0．05），Ⅰa与Ⅱa、Ⅲa组比较差异无统计学意义（P〉0．05），Ⅱb组低于Ⅰb组（P〈0．05），Ⅱb与Ⅲb组比较无统计学差异（P〉0．05），Ⅱc组低于Ⅱc组（P〈0．05）。结论丙泊酚注射人工流产术时无注射痛者无需给予术后镇痛，轻微注射痛者仅给予布托啡诺镇痛就足够，中、重度注射痛者给予布托啡诺和下腹部物理治疗联合镇痛效果更优。

Prediction of postoperative analgesia by assessing the intravenous propofol injection-induced pain in artificial abortion

Objective To explore the feasibility of selecting postoperative analgesia methods by assessment of propofol injection pain in artificial abortion. Methods One thousand five hundred pregnant women with artificial abortion were randomly divided into three groups. The women in group Ⅰ were received normal saline, group Ⅱ were injected with butorphanol 1 mg; and group Ⅲ were received butorphanol 1 mg and added abdominal physical therapy. Every group was divided into 3 subgroups again： VRS= 0 was in subgroup a; VRS= 1 in subgroup b; VRS≥2 in subgroup c. Anesthesia was induced with propofol 2 mg/kg in each group. At the time one quarter of the total induction dose was injected via a same forearm vein, pain induced by intravenous propofol injection was assessed with VRS. Then the rest part of the induction dose was injected. Postoperative abdominal pain was assessed with visual analogue scale （VAS） at 30 min after the abortion. Results The post- operative pain rate in group Ⅱ or Ⅲ was significantly lower than that in group Ⅰ （P〈0.05）, but there was no difference among the all subgroups （P〉0.05）. Subgroup Ⅱb was lower than subgroup Ⅰb （P〈0.05）, while subgroup Ⅲ c was lower than Ⅱ c （P〈0.05）. Conclusion Pregnant women with no injection pain need no postoperative analgesia, mild injection pain （VRS： 1） only need butorphanol, and middle and heavy injection pain （VRS≥2） need both butorphanol and physiotherapy after the artificial abortion anethetized with propofol.