不同手术室噪声对无痛人流手术麻醉的影响  

The effects of noise exposure on anesthetic effect of propofol for induced abortion

作　　者：汪芳俊[1] 胡建华[1] 涂发平[1] 刘洋[1] 

机构地区：[1]川北医学院附属医院麻醉科,四川省南充市637000

出　　处：《临床麻醉学杂志》2014年第8期762-765,共4页Journal of Clinical Anesthesiology

摘　　要：目的 观察不同手术室噪声对无痛人流手术麻醉的影响.方法 选择行人工流产术全麻患者120例,随机分为A组（噪声为30～40 dB）、B组（噪声为50～60 dB）和C组（噪声为70～80 dB）,每组40例.静脉推注芬太尼1μg/kg、丙泊酚2.0 mg/kg行麻醉诱导,根据患者意识情况可分次追加丙泊酚0.5 mg/kg,待其意识消失后开始手术.术中根据患者对手术刺激的反应,必要时分次追加丙泊酚0.5 mg/kg.记录噪声干预前5 min（T0）、麻醉诱导前1 min（T1）、手术开始后1、3、5、10 min（T2、T3、T4、T5）以及术后患者清醒时（T6）的MAP、HR、SpO2和BIS值.观察并记录丙泊酚麻醉诱导剂量,同时记录术中追加丙泊酚的剂量;观察人流综合征的发生情况和术后恶心呕吐情况;评价麻醉效果和患者梦境感受并记录患者苏醒时间和离院时间.结果 与T0时比较,T1时B、C组MAP和BIS明显升高（P＜0.05）,HR明显增快（P＜0.01）,且明显高于和快于A组（P＜0.05或P＜0.01）;T2时三组MAP和BIS均明显降低（P＜0.01）,HR明显减慢（P＜0.05）;T3、T4时三组BIS仍明显降低（P＜0.01）,但T4时B、C组BIS明显高于A组（P＜0.05）;T5、L时B、C组MAP明显升高（P＜0.05或P＜0.01）,HR明显增快（P＜0.01）,且明显高于和快于A组（P＜0.05或P＜0.01）,B、C组BIS明显高于A组（P＜0.05）.与C组比较,A、B组麻醉效果明显提高（P＜0.05）,A组丙泊酚诱导剂量和术中追加剂量明显减少（P＜0.05）.与A组比较,B、C组苏醒时间与离院时间明显延长（P＜0.05）,梦境难受率明显升高（P＜0.05）.结论 手术室噪声不仅影响丙泊酚无痛人流手术麻醉的效果,还会加重患者的紧张和焦虑.Objective To investigate the effects of noise exposure on anesthetic effect of propofol for induced abortion.Methods One hundred and twenty patients,undergoing induced abortion,were randomly divided into three groups （n=40 each）：group A （noise level was 30-40 dB）,group B （noise level was 50-60 dB） and group C （noise level was 70-80 dB）.Anesthesia was induced with fentanyl 1 μg/kg and propofol 2.0 mg/kg followed by bolus propofol 0.5 mg/kg whenever needed during the operation.The mean blood pressure （MAP）,heart rate（HR）,pulse oxygen saturation （SpO2） and the bispectral index （BIS） were recorded at 5 minutes（T0） before noise exposure,1 minute（T1）before induction of anesthesia,1 minute（T2）,3 minutes（T3）,5 minutes （T4） and 10 minutes （T5）from the beginning of operation and at the moment patients recovery from anesthesia （T6）.Both the amount of propofol required for anesthesia induction and anesthesia maintenance,and the incidence of abortion syndrome,nausea and vomitting were recorded.The anaesthetic quality and the feeling of the dream during operation,the time from iv injection of propofol to both patients came round after the anaesthetic and could go home by themselves were observed and recorded.Results The MAP,HR and BIS were increased significantly in group B and C at T1 compared with T0 and group A（P＜0.05 or P＜0.01）.The MAP,HR and BIS were decreased significantly in all three groups at T2 （P＜0.05 or P＜0.01）.The BIS was decreased obviously in all three groups at T3 and T4 （P＜0.01）,whereas the BIS was higher in group B and C than in group A at T4 （P＜0.05）.The MAP and HR were increased significantly in group B and C at T5 and T6 compared with T0 and group A（P＜0.05 or P＜0.01）,meanwhile the BIS was higher in group B and C than in group A（P ＜0.05）.Compared to group C,the quality of anesthesia was better in group A and B（P＜0.05）,the amount of propofol for induction and maintenance were less obviously in group

关 键 词：手术室噪声 人工流产术 丙泊酚 

分 类 号：R169.42[医药卫生—公共卫生与预防医学]