舒芬太尼在终止8～14周妊娠中的最佳麻醉剂量探讨

目的探讨舒芬太尼在终止8¹4周妊娠中的最佳麻醉剂量。方法选择2008年2月—2011年5月自愿终止妊娠的妇女90名,随机分为A组、B组和C组各30名,术前4 h均于阴道后穹隆填塞米索前列醇0.2 mg,术前静脉推注0.5mg/kg盐酸利多卡因,A组静脉推注舒芬太尼0.15μg/kg,B组静脉推注舒芬太尼0.20μg/kg,C组静脉推注舒芬太尼0.25μg/kg,然后均缓慢静脉推注丙泊酚。比较三组术前、术中、术后BP、HR、RR、SpO2、丙泊酚使用量、清醒时间、离院时间,并对麻醉效果、术后镇痛效果及术后恶心呕吐情况进行评级。计量资料采用t检验,等级资料采用秩和检验,P<0.05为差异有统计学意义。结果 C组术中RR(10.0±4.0)次/min、SpO(289.1±4.2)%与A组RR(12.0±3.0)次/min、SpO(293.3±2.0)%]、B组RR(11.3±2.9)次/min、SpO(292.4±2.3)%]比较差异均有统计学意义(均P<0.05),C组术中RR、SpO2与术前RR(18.9±3.6)次/min、SpO(297.4±1.6)%]、术后RR(16.7±3.2)次/min、SpO(296.6±1.4)%]比较差异均有统计学意义(均P<0.05),C组丙泊酚用量(0.9±0.2)mg/kg较A组(1.5±0.3)mg/kg]和B组(1.4±0.3)mg/kg]减少,差异均有统计学意义(均P<0.05),C组离院时间(21.2±4.2)min较A组(16.0±3.2)min]和B组(16.2±2.8)min]有所延长,差异均有统计学意义(均P<0.05)。麻醉效果014周妊娠中的最佳麻醉剂量。方法选择2008年2月—2011年5月自愿终止妊娠的妇女90名,随机分为A组、B组和C组各30名,术前4 h均于阴道后穹隆填塞米索前列醇0.2 mg,术前静脉推注0.5mg/kg盐酸利多卡因,A组静脉推注舒芬太尼0.15μg/kg,B组静脉推注舒芬太尼0.20μg/kg,C组静脉推注舒芬太尼0.25μg/kg,然后均缓慢静脉推注丙泊酚。比较三组术前、术中、术后BP、HR、RR、SpO2、丙泊酚使用量、清醒时间、离院时间,并对麻醉效果、术后镇痛效果及术后恶心呕吐情况进行评级。计量资料采用t检验,等级资料采用秩和检验,P<0.05为差异有统计学意义。结果 C组术中RR(10.0±4.0)次/min、SpO(289.1±4.2)%与A组RR(12.0±3.0)次/min、SpO(293.3±2.0)%]、B组RR(11.3±2.9)次/min、SpO(292.4±2.3)%]比较差异均有统计学意义(均P<0.05),C组术中RR、SpO2与术前RR(18.9±3.6)次/min、SpO(297.4±1.6)%]、术后RR(16.7±3.2)次/min、SpO(296.6±1.4)%]比较差异均有统计学意义(均P<0.05),C组丙泊酚用量(0.9±0.2)mg/kg较A组(1.5±0.3)mg/kg]和B组(1.4±0.3)mg/kg]减少,差异均有统计学意义(均P<0.05),C组离院时间(21.2±4.2)min较A组(16.0±3.2)min]和B组(16.2±2.8)min]有所延长,差异均有统计学意义(均P<0.05)。麻醉效果0^Ⅲ级A组分别为18、5、4、3例,B组分别为27、3、0、0例,C组分别为28、2、0、0例;术后镇痛效果0Ⅲ级A组分别为18、5、4、3例,B组分别为27、3、0、0例,C组分别为28、2、0、0例;术后镇痛效果0^Ⅱ级A组分别为24、4、2例,B组分别为28、1、1例,C组分别为29、1、0例;术后恶心呕吐情况0Ⅱ级A组分别为24、4、2例,B组分别为28、1、1例,C组分别为29、1、0例;术后恶心呕吐情况0^Ⅱ级A组分别为27、3、0例,B组分别为26、3、1例,C组分别为17、8、5例。与B组、C组比较,A组的麻醉效果、术后镇痛效果较差,比较差异均有统计学意义(均P<0.05),C组术后恶心呕吐情况与A组、B组比较差异均有统计学意义(均P<0.05)。结论选择合适剂量的舒芬太尼复合盐酸利多卡因和丙泊酚终止8Ⅱ级A组分别为27、3、0例,B组分别为26、3、1例,C组分别为17、8、5例。与B组、C组比较,A组的麻醉效果、术后镇痛效果较差,比较差异均有统计学意义(均P<0.05),C组术后恶心呕吐情况与A组、B组比较差异均有统计学意义(均P<0.05)。结论选择合适剂量的舒芬太尼复合盐酸利多卡因和丙泊酚终止8¹4周妊娠具有呼吸循环抑制轻、清醒迅速、离院时间短、临床麻醉和术后不良反应小等优点,值得推广。

Optimum dose of sufentanil in terminating 8-14 weeks of gestation

Objective To explore the optimal dose of sufentanil in terminating 8-14 weeks of gestation.Methods Ninety women with 8-14 weeks pregnancy from February 2008 to May 2011 were randomly divided into three groups,30 women for each group. All women were given misoprostol 30 minutes before operation and lidocaine 0.5 mg/kg before operation.Group A received sufentanil in a dose of 0.15 μg/kg,group B 0.20 μg/kg and group C 0.25 μg/kg.All groups were monitored for blood pressure（BP）,heart rate（HR）,respiratory rate（RR）,oxygen saturation（SpO2） before anesthesia,during operation and after operation,as well as propofol consnmption,recovery time,discharging time from the hospital and postoperative nausea and vomiting, and then narcotic analgesic effect was rated.T-test was used for measurement data,and rank-sumtest for ordinal data.h showed significant diference,when P was less than 0.05.Results During operation,the values of RR and SpO2 in group C were significantly different from those in group A and Bgroup C： RR（10.0 ± 4.0）breaths/min,SpO2（89.1 ± 4.2）%;group A：RR（12.0 ± 3.0）breaths/min,SpO2（93.3± 2.0）%; group B：RR （11.3 ±2.9）breaths/min,SpO2（92.4 ± 2.3）%,all P〈0.05];the intraoperative values of RR and SpO2 were（18.9±3.6）breaths/min and SPO2（97.4± 1.6）% respectively in group C,which were significantly different from postoperative onesRR（16.7 ±3.2）breaths/min, SpO2 （96.6±1.4）%,all P〈 0.05].Propofol consumption was （0.9 ±0.2）mg/kg,（1.5± 0.3）mg/kg and （1.4 ± 0.3）mg/kg respectively in group C,B and A.Group C had a lower propofol consumption than the other two groups and significant difference was found between them（both P〈0.05）.The discharging time from hospital in group C（21.2± 4.2）min]was longer than that in group A and B （16.0 ±3.2）min and（16.2 ±2.8）min],which showed significant difference（all P〈0.05）;group A had poor narcotic and postoperative analgesic effects than group B and C,which was statistically significant（all P〈0.05）;postoperative nausea and vomiting got significantly improved in group C than in group A and B （all P〈0.05）.Conclusion Optimal dose of sufentanil with propofol in terminating 8-14 weeks of gestation has little influence on respiration and circulation,with the merits of rapid recovery from anesthesia, short hospital stay and fewer anesthesia side effects and postoperative adverse reactions,which is worthy of being applied clinically.