地佐辛复合丙泊酚用于无痛人工流产术的最佳剂量探讨

目的探讨地佐辛复合丙泊酚用于无痛人工流产术（人流术）的临床效果、合适剂量及其安全性。方法按入室顺序随机将200例ASAI或Ⅱ级自愿接受门诊无痛人工流产手术的宫内妊娠患者均分为A、B、C、D4组（n=50），A、B、C组分别静脉注射地佐辛0．10、0．15、0．20mg／kg，D组静脉注射芬太尼1．5μg/kg；3min后4组均缓慢静脉注射1％丙泊酚。观察比较各组麻醉诱导前（T0）、睫毛反射消失时（T1）、苏醒时（T2）和苏醒后10min（T3）的MAP、HR、RR、SpO2；麻醉诱导时间、麻醉苏醒时间、定向力恢复时间；丙泊酚诱导用量及总用量；术中、术后镇痛效果及不良反应。结果A、D组T1时MAP、HR、RR、SpO2均较该组T0时下降（P〈0．05）；B组T1时MAP、HR较Tn时下降（P〈0．05）；B、C组麻醉苏醒时间和定向力恢复时间均短于A、D组（P〈0．05），A、D组组间比较差异有统计学意义，B、C组组间比较差异无统计学意义（P〉0．05）；丙泊酚诱导剂量及总用量C组〈B组〈D组〈A组，组间比较差异有统计学意义（P〈0．05）。B、C组术中镇痛效果及术后疼痛评分分级和术中体动反应发生率与A、D组比较差异均有统计学意义，B、C组间比较差异无统计学意义（P〉0．05）；B、C组术中呼吸抑制和术后恶心、呕吐等不良反应发生率均低于A、D组（P〈0．05），且B组低于C组。结论地佐辛复合丙泊酚用于无痛人流术镇痛效果确切，呼吸抑制、恶心呕吐等不良反应少，安全性好，0．15mg／kg是最佳剂量。

Study on the optimal dosage of Dezocine combined with propofol used in painless induced abortion

Objective To investigate the clinical effect, suitable dose, and its safety of dezocine combined with propofol used in painless artificial abortion. Methods With a completely randomized double blind method, 200 cases of ASA Ⅰ or Ⅱ early intrauterine pregnancy patients were divided into A, B, C, and D four groups （ n =50）. Each patient in A, B, and C groups was infused dezocine in 0. 10, 0. 15, and 0. 20 mg/Kg, respectively. D group was administrated with intravenous fentanyl 1.5 p. g/kg, then 3 min later, slowly intravenous injection of 1% of propofol. MAP, HR, RR, and SpO2 were recorded at the before anesthesia induction （ T0 ） , loss of eyelash reflex time （ T1 ） , recovery time （ T2 ） , and recovery 10 - min time （ T3 ）. Meanwhile, the parameters including the anesthesia induction time, anesthesia recovery time, directional force recovery time, induction dosage and total dosage of propofol, and the intraopcrative and postoperative analgesic efficacy and adverse reaction were compared among different groups. Results For theAand D groups, MAP, HR, RR, and SpO2 at the T1 were all lower than that at the T0（ P 〈 0. 05）. For the B group, MAP and HR at the T1 were lower than that at the T0 （ P 〈 0. 05）. The anesthesia recovery time and orientation recovery time in the B and C groups were significantly shorter than A and D groups （ P 〈 0. 05）, and significantly statistical difference was found between A and D groups, no statistical difference between B and C groups （ P 〉 0.05）. The propofol induction dosage and total dosage were different among groups （ groups C 〈 B 〈 D 〈 A） with a statistical significance （ P 〈 0. 05 ）. The intraoperative analgesia effect, postoperative pain score grading, and intraoperative body dynamic reaction rates in the B and C groups were significantly different from the A and D groups （ P 〈 0. 05 ）, and no statistical significance was found between B and C groups （ P 〉 0. 05 ）. The respiratory inhibition, postoperative nausea, vomiting and other adverse reaction rates in the B and C groups were significantly lower than those in A and D groups （ P 〈 0. 05）, and those parameters in B group were lower than C group. Conclusions Dezocine combined with propofol is definitely effective and very safe in painless induced abortion with very less respiratory inhibition, nausea, vomiting, and other adverse reactions; and their optimal dosage is 0. 15 mg/kg.