布托啡诺对丙泊酚人工流产病人麻醉深度的影响

目的 观察布托啡诺对丙泊酚人工流产麻醉深度的影响。方法 选择自愿接受人工流产择期手术的初孕患者40例（ASA I～II级）随机均分为两组，每组20例，A组为单纯丙泊酚组，静脉注射丙泊酚直至睫毛反射消失；B组为布托啡诺复合丙泊酚组，麻醉诱导前5 min先缓慢静脉注射布托啡诺,，5 min后开始缓慢静脉注射丙泊酚至睫毛反射消失。记录手术前、诱导后、扩张子宫颈部时、刮宫时、手术结束时的血压、心率、脉搏氧饱和度、呼吸次数、脑电双频指数（BIS）、丙泊酚使用量、恢复时间、手术中体动的次数、手术后1,4 h可能存在的不良反应及患者下腹部疼痛程度。结果 两组患者手术前年龄、体重、孕周、手术方法、手术时间基本相同（P>0.05）；手术中血压、心率、脉搏氧饱和度和恢复时间基本相似（P>0.05）。丙泊酚使用量A组（182 42）mg多于B组(140 32) mg（P<0.05）；手术前A组BIS值为（96 6），B组（98 2）。诱导后A组BIS为（37.8 10.0）、B组为（44.4 10.2）（P<0.05），手术中扩张子宫颈时A组BIS变化值（48.9 17.9）较B组数值（54.3 14.4）略低（P<0.05）， B组体动要明显少于A组（P<0.05），手术后4 h恶心、呕吐、头痛，头晕及患者下腹部疼痛程度两组间差异均无显著性（P>0.05）。结论 布托啡诺复合丙泊酚用于门诊无痛人流麻醉比单纯静脉注射丙泊酚能更有利于调控麻醉深度，有效控制手术中体动反应，且减少丙泊酚用量。 【关键词】布托啡诺 丙泊酚 人工流产 脑电双频指数

The effect of prior administration of Butorphanol on the depth of Anesthesia during propofol Anesthesia in suction termination of pregnancy

【Abstract】 Objective To investigate the effect of prior administration of Butorphanol on the depth of Anesthesia during propofol Anesthesia in suction termination of pregnancy. Methods 40 patients (ASAI～II) undergoing the suction termination of pregnancy were randomly allocated into two groups. In group A (control, n = 20) the patients were given propofol until eyelash reflex lost. In group B (n = 20), 5min before propofol infusion, the patients were administrated 0.02 mg• kg-1 Butorphanol. The changes of ECG, SBP/DBP, HR, SpO2, the bispectrial index (BIS) and RR were monitored at the moment of consciousness, after Induction, dilating cervix, curettage of uterine and the end of operation. The dosage of propofol, Extremities movement response (EMR) and the time that the patients regained consciousness and orientation were also recorded. In addition, the patient’s chief complaint was observed and the status of pain was assessed by measuring VAS at 1h and 4h after operation. Results Statistical analysis revealed no significant difference in age, weight, gestation weeks, operation methods and the time of operation（P>0.05）. In addition, no differences were observed in SBP/DBP, HR, SPO2 and the time that the patients regained consciousness and orientation（P>0.05）between 2 groups. Group B notably reduced the consumption of propofol to (14032) mg compared with Group A（18242）mg（P<0.05）; The value of conscious BIS revealed no difference between group A and group B; after induction, the value of group A was(37.810.0), while group B was (44.410.2); at the moment of dilating cervix, the value of group A was（48.917.9）and group B was（54.314.4）（P<0.05）. EMR was minimized in group B compared with group A（P<0.05）.At the time 4h after operation, no significant differences were detected in the adverse effects in both groups. Conclusions Propofol combined with Butorphanol for intravenous anesthesia in suction termination of pregnancy may be benefit for analgesia, control of the depth of anesthesia, reduction of the EMR and the consumption of propofol.