文章摘要

对比不同流速丙泊酚在人工流产手术中的应用效果

作者: 1王超, 1肖广莉
1 上海交通大学医学院附属第九人民医院麻醉科,上海 201999
通讯: 肖广莉 Email: jymz20220217@163.com
DOI: 10.3978/j.issn.2095-6959.2022.07.020

摘要

目的:对比分析不同流速丙泊酚在人工流产手术中的应用效果。方法:选择上海交通大学医学院附属第九人民医院2019年7月至2021年7月上海交通大学医学院附属第九人民医院门诊接受人工流产手术患者114例作为研究对象。采用随机数字表法将所选患者分为A组与B组,各57例。分别按照10 s(A组)和30 s(B组)对患者注射丙泊酚(3.0 mg/kg)实施静脉麻醉。记录并比较两组镇静成功率、麻醉起效时间、苏醒时间、离室时间、麻醉药物追加例数及次数,此外比较两组麻醉前(T0)、放置扩阴器时(T1)、吸宫时(T2)、术后10 min(T3)的收缩压(systolic blood pressure,SBP)、舒张压(diastolic blood pressure,DBP)、心率(heart rate,HR)、脉搏血氧饱和度(pulse oxygen saturation,SpO2)并分析术中呼吸、循环抑制情况,记录术后不良反应情况。结果:两组镇静成功率均为100%。与A组比较,B组患者麻醉起效时间明显延长(P<0.05),两组患者麻醉苏醒时间、离室时间、麻醉药物追加例数及追加次数差异均无统计学意义(P>0.05);与T0时比较,两组T1、T2、T3时SBP、SpO2均明显降低(P<0.05),且T3时逐步恢复,此外A组T1时SpO2明显低于B组(P<0.05);A组诱导后呼吸抑制(术中SpO2<95%)发生率明显高于B组(P<0.05),此外A组术中给予初级呼吸支持数明显高于B组(P<0.05),术中SBP下降超过基础值20%患者占比明显高于B组(P<0.05);术后不良反应有恶心、呕吐、流涎、寒战、头晕(麻醉苏醒期麻醉后遗效应)等,但症状均较轻微,未经处理自然缓解。两组不良反应发生率比较,差异无统计学意义(P>0.05)。结论:人工流产术患者实施自主呼吸静脉麻醉时相对偏慢(建议30 s以上)的注射流速可使呼吸和循环抑制程度减轻,血压波动减小。
关键词: 丙泊酚;麻醉;人工流产;呼吸抑制;循环抑制;注射速度

Comparison of application effect of propofol with different flow rates in induced abortion

Authors: 1WANG Chao, 1XIAO Guangli
1 Department of Anesthesiology, Ninth People’s Hospital Affiliated to Medical College of Shanghai Jiao Tong University, Shanghai 201999, China

CorrespondingAuthor: XIAO Guangli Email: jymz20220217@163.com

DOI: 10.3978/j.issn.2095-6959.2022.07.020

Abstract

Objective: To compare and analyze the effects of propofol with different flow rates in induced abortion. Methods: A total of 114 outpatients of our hospital who underwent induced abortion from July 2019 to July 2021 were selected as the research subjects. They were divided into group A and group B by random number table method, with 57 cases in each group. They were injected with propofol (3.0 mg/kg) for intravenous anesthesia according to 10 s (group A) and 30 s (group B) respectively. The anesthesia conditions (including the success rate of sedation, the onset time of anesthesia, the recovery time, the time of leaving the room, the number and times of additional anesthetic drugs) of the two groups were recorded and compared. In addition, the systolic blood pressure (SBP), diastolic blood pressure (DBP), heart rate (HR) and pulse oxygen saturation (SpO2) before anesthesia (T0), when the vaginal dilator was placed (T1), during uterine aspiration (T2) and 10 min after operation (T3) were compared between the two groups. The inhibition of respiratory and circulatory circulation during operation was analyzed, and the adverse reactions after operation were recorded. Results: The success rate of sedation in both groups was 100% (57/57). Compared with group A, the onset time of anesthesia in group B was significantly longer (P<0.05), and there was no significant difference in anesthesia recovery time, departure time, number of additional cases and times between the two groups (P>0.05); compared with T0, SBP and SpO2 decreased significantly at T1, T2 and T3 in the two groups (P<0.05), and gradually recovered at T3. In addition, SpO2 at T1 in group A was significantly lower than that in group B (P<0.05); the incidence of respiratory depression (intraoperative SpO2 <95%) after induction in group A was significantly higher than that in group B (P<0.05). In addition, the number of primary respiratory support given in group A was significantly higher than that in group B (P<0.05), and the proportion of patients whose SBP decreased by more than 20% during operation was significantly higher than that in group B (P<0.05); the postoperative adverse reactions included nausea, vomiting, salivation, chills, dizziness (aftereffect of anesthesia during anesthesia awakening), but the symptoms were mild and naturally relieved without treatment. There was no significant difference in the incidence of adverse reactions between the two groups (P>0.05). Conclusion: Patients undergoing induced abortion are relatively slow to implement spontaneous respiratory intravenous anesthesia (more than 30s is recommended). The injection flow rate can reduce the inhibition of respiration and circulation and the fluctuation of blood pressure.

Keywords: propofol; anesthesia; induced abortion; respiratory depression; circulation inhibition; injection speed

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