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目的通过临床研究,探讨用丙泊酚进行无痛人流麻醉的方案选择。方法选择2010年1月至2012年1月在我院行无痛人流手术患者200例,随机分为4组,A组(丙泊酚组),单纯给予2mg/kg丙泊酚;B组(丙泊酚+芬太尼组),先给予0.05mg芬太尼后给予2mg/kg丙泊酚;C组(丙泊酚+米索前列醇组),在术前2h阴道后穹放置米索前列醇400μg,手术开始时给予2mg/kg丙泊酚;D组(丙泊酚+芬太尼+米索前列醇组),在术前2h阴道后穹放置米索前列醇400ug,手术开始时先给予0.05mg芬太尼后给予2mg/kg丙泊酚。记录观察患者血压、脉搏、氧饱和度、宫颈松弛度、手术时间、离院时间、丙泊酚用量、人流综合症及患者满意度。结果 4组患者一般情况年龄、体质量、产次、孕次、孕天无统计学意义(P>0.05),血压、脉搏、氧饱和度各组术前、术中、术后无明显变化(P>0.05),出血量、离院时间4组间无明显差异(P>0.05);手术时间A组和B组、C组和D之间没有差别(P>0.05),而A、B两组和C、D组比较有明显的区别(P<0.01)。异丙酚使用量各组之间均有差别(P<0.01)。A组用量最多,D组用量最少。宫颈松弛度C、D组明显优于A、B组。术后满意度调查术前准备C、D组稍显繁琐(各占12%和8%)。舒适度C、D组明显优于其他两组(分别占84%和94%),4组无一例术中知晓。人流综合症A组发生2例,其余3组无一例发生。结论术前阴道后穹放置米索前列醇400ug,芬太尼0.05mg辅以丙泊酚2mg/kg行无痛人流术,操作可行性强、费用低廉、安全性高、患者满意度高,是较好的无痛人流麻醉方案,值得在临床上推广。
Objective To investigate the clinical options of using propofol for pain-free anesthesia. Methods A total of 200 patients with painless abortion in our hospital from January 2010 to January 2012 were randomly divided into 4 groups: group A (propofol), propofol (2mg / kg); group B Propofol + fentanyl group), given 0.05mg fentanyl after giving propofol 2mg / kg; C group (propofol + misoprostol group), 2h preoperative intravaginal placement of misoprostol 400 μg of prophenol was given at the beginning of the operation, and 2 mg / kg of propofol was given at the beginning of the operation. In group D (propofol + fentanyl + misoprostol group), 400 μg of misoprostol was placed in the vaginal posterior for 2 h before surgery 2 mg / kg propofol was given after giving 0.05 mg fentanyl first. Blood pressure, pulse, oxygen saturation, cervical relaxation, operation time, hospital stay, propofol dosage, flow syndrome and patient satisfaction were recorded. Results There were no significant differences in age, body weight, parity, gestational age, and pregnancy between the four groups (P> 0.05). There were no significant changes in blood pressure, pulse rate and oxygen saturation before and after surgery There was no significant difference between the two groups (P> 0.05), the amount of bleeding and the time of leaving hospital (P> 0.05). There was no difference between group A and group B, group C and group D (P> 0.05) There was a significant difference between group C and group D (P <0.01). Propofol consumption varied among groups (P <0.01). Group A used the most, Group D used the least. Cervical relaxation C, D group was significantly better than A, B group. Postoperative satisfaction survey Preoperative C, D group slightly cumbersome (each 12% and 8%). Comfort C, D group was significantly better than the other two groups (84% and 94%, respectively), 4 cases without any intraoperative awareness. Two cases occurred in group A with flow-induced syndrome and none in the other three groups. Conclusions Preoperative vaginal vault placed misoprostol 400ug, fentanyl 0.05mg supplemented with propofol 2mg / kg painless abortion, the feasibility of operation, low cost, high safety, patient satisfaction is high Better painless anesthesia program, it is worth in the clinical promotion.