三种镇痛药辅助异丙酚静脉全麻用于人工流产术的效果比较

目的　观察比较泰勒宁、芬太尼或氯诺昔康辅助异丙酚静脉全麻用于人工流产术的麻醉效果。方法　选择自愿接受全麻下人工流产孕妇 4 0 0例 ,随机分为对照组 (C)、芬太尼组 (F)、泰勒宁组 (T)和氯诺昔康组 (L)四组 ,每组 10 0例。C组不给任何辅助性镇痛药、T组术前 1h口服泰勒宁 1片、L组先静注 0 14mg/kg的氯诺昔康、F组将 1μg/kg的芬大尼加入异丙酚中。各组均按 2 2mg/kg的异丙酚剂量于 6 0s内静脉注射完毕 ,待睫毛反射消失后即行人流操作。观察SBP、DBP、HR、R及SpO2 ;术毕记录不适反应。结果　四组受术者在异丙酚麻醉后 2min ,SBP、DBP、R、SpO2 与麻醉前比较 ,有显著性差异 ,HR则无明显变化 ;术毕诉注射部位疼痛和下腹痛 (宫缩痛 )者 ,T、F、L组与C组比较有显著性差异 ,但其VAS评分均为 3～ 6 ,属轻、中度疼痛。结论　泰勒宁、氯诺昔康、芬太尼辅肋异丙酚静脉全麻用于人工流产镇痛时具有镇痛效果确切、术中呼吸循环功能基本稳定、术毕宫缩痛发生率低、清醒程度高、并发症少等优点。

THE CLINICAL STUDY ON USING THREE KINDS OF ANALGESICS TO ASSIST PROPOFOL FOR A GENERAL ANESTHESIA ON ARTIFICIAL ABORTION PATIENTS

Objective To compare the efficacy of using tylox , fentanyl and lornoxican to assist propofol for a general anesthesia on artificial abortion patients. Methods 400 pregnant women (with 45～60 days pregnant) were randomly divided into four groups with 100 patients in each group. Before propofol was given, group C (contrast) was not given any auxiliary analgesic; group T (tylox) took one tablet of tylox an hour before operation; group L was given lornoxicam iv by 0.14 mg/kg; in group F, 1 μg/kg fentanyl was put into propofol. After each group was given iv propofol by 2.2 mg/kg in 60s and eyelash areflexia, artificial abortion operation was made. And then SBP, DBP, HR, R and SpO 2 were observed. The anesthesia effects were evaluated by three levers, excellent, fine and poor. Results Four group patients were not obviously different in age, weight and height. There is no statistic difference between four groups in the time of taking anesthesia effect, maintaining and awaking. In four groups, SBP, DBP, R, SpO 2 had some difference in the statistics compared with the comparative change before anesthesia, HR had no obvious change; 15 patients in group C, 17 in group T, 21 in group F, 16 in group L had temporary apnea. After the first dosage was given, there were more patients with excellent anesthesia effects in group T, F, L than in group C. Compared with group C, the patients in group T, F, L telling ache in injection site and lower abdominal pain had obviously difference after operation. Conclusions Using tylox, fentanyl and lornoxican to assist propofol for a general anesthesia on artificial abortion patients has very good effect, in addition, respiratory function is stable during the operation, incidence of uterine contraction is low, the degree of wakefulness was high and there is few complication.