论文部分内容阅读
目的:比较芬太尼、瑞芬太尼和舒芬太尼联合异丙酚在人工流产镇痛中的镇痛效果、并发症的发生率和唾液皮质醇的变化,探索一种安全有效的人工流产镇痛药物组合。方法:选择妊娠6~12周的患者240例,随机分为芬太尼组(F组)、瑞芬太尼组(R组)和舒芬太尼组(S组),每组80例。手术前1小时阴道放置米索前列醇400μg,手术开始前静脉推注麻醉性镇痛药:F组芬太尼1.5μg/kg,R组瑞芬太尼1.5μg/kg,S组舒芬太尼0.1μg/kg;接着追加异丙酚2 mg/kg。记录生命体征变化,观察宫颈松弛程度、手术时间、术后唤醒时间,观察术中呼吸抑制、术后恶心呕吐、下腹疼痛情况和手术前、后的唾液皮质醇的变化。结果:3组的手术时间、宫颈松弛度、体动反应差异无显著性意义(P>0.05)。S组苏醒时间比F、R组长(P<0.05)。R和S组的低血压发生率比F组高(P<0.05);R和S组的呼吸抑制发生率比F组高(P<0.05)。3组术后30min、2 hr疼痛VAS评分R组比F、S组高(P<0.05)。术后1天R组皮质醇比F、S组高(P<0.05),而F、S组之间差异无统计学意义。结论:芬太尼或瑞芬太尼比舒芬太尼联合异丙酚更适合作为人工流产的镇痛药物。
OBJECTIVE: To compare the analgesic effects of fentanyl, remifentanil and sufentanil with propofol in abortion analgesia, the incidence of complications and changes in saliva cortisol, and to explore a safe and effective artificial Abortion analgesics combination. Methods: A total of 240 pregnant women were enrolled in this study. They were randomly divided into fentanyl group (F group), remifentanil group (R group) and sufentanil group (S group), 80 cases in each group. 400 micrograms of misoprostol was placed vaginally one hour before surgery, and intravenous anesthetic analgesics were administered before the start of surgery: fentanyl 1.5 μg / kg in group F, remifentanil 1.5 μg / kg in group R, 0.1 μg / kg; followed by propofol 2 mg / kg. Changes of vital signs were observed, the degree of cervical relaxation, operation time, wake time after operation, respiratory depression, postoperative nausea and vomiting, abdominal pain and changes of saliva before and after surgery were observed. Results: There was no significant difference in operative time, cervical relaxation and body movement between the three groups (P> 0.05). The recovery time in group S was longer than that in group F and group R (P <0.05). The incidence of hypotension in R and S group was higher than that in F group (P <0.05). The incidence of respiratory depression in R and S group was higher than that in F group (P <0.05). The VAS score of 2 hours pain relief in group 3 was higher than that in group F and S at 30 minutes after operation (P <0.05). One day after operation, the cortisol in R group was higher than that in F and S groups (P <0.05), but there was no significant difference between F and S groups. Conclusions: Fentanyl or remifentanil is more suitable than sufentanil plus propofol as an analgesic for induced abortion.