静脉注射丙泊酚速度对人工流产手术患者麻醉效果的影响  

Anesthetic efficacy of propofol at two injection rates on the patients undergoing artificial abortion

作　　者：肖成娇 顾夏芳 杨芳[2] 刘华跃[1] 金鑫[1] XIAO Cheng-jiao;GU Xia-fang;YANG Fang;LIU Hua-yue;JIN Xin(Department of Anesthesiology,First Affiliated Hospital of Soochow University,Suzhou 215031,Jiangsu,China;Department of Gynaecology and Obstetrics,First Affiliated Hospital of Soochow University,Suzhou 215031,Jiangsu,China;Department of Anesthesiology,the Second People′s Hospital of Xiangcheng District,Suzhou 215143,Jiangsu,China)

机构地区：[1]苏州大学附属第一医院麻醉科,苏州215031 [2]苏州大学附属第一医院妇产科,苏州215031 [3]苏州市相城区第二人民医院麻醉科,苏州215143

出　　处：《医学研究生学报》2021年第7期745-749,共5页Journal of Medical Postgraduates

摘　　要：目的既往关于门诊手术患者静脉麻醉时注射丙泊酚速度鲜有报道。文中探讨不同速度静脉注射丙泊酚对人工流产手术患者麻醉效果的影响,以为门诊手术患者实施保留自主呼吸静脉麻醉提供参考。方法收集2020年11月9日至2021年1月29日于苏州大学附属第一医院行人工流产手术患者60例,并采用随机数字表分成2组,每组30例。分别按照10 s(快速组)和30 s(慢速组)对患者注射丙泊酚(3.0 mg/kg)实施静脉麻醉。记录患者麻醉起效时间、苏醒时间、静脉注射痛、体动反应、呼吸抑制、循环抑制和术后不良反应情况。结果慢速组患者比快速组麻醉起效时间显著延长[(59.0±17.1)s vs(39.2±13.8)s,P<0.01],两组患者苏醒时间差异无统计学意义[(225.8±117.8)s vs(279.9±119.1)s,P=0.0821]。与快速组比较,慢速组患者脉搏氧饱和度下降程度较轻(P=0.0084),氧饱和度低于95%比例较小(30.0%vs 66.7%,P=0.0483),需要呼吸支持比例较小(3.3%vs 20.0%,P=0.0444)。慢速组患者术中收缩压下降超过基础值20%比例较小(10.0%vs 33.3%,P=0.0283)。组间患者静脉注射痛、体动反应、术中心率变化和术后不良反应等差异均无统计学意义(P>0.05)。结论给人工流产手术患者实施保留自主呼吸静脉麻醉,相对偏快速度注射丙泊酚可使麻醉起效时间缩短,而相对偏慢速度注射丙泊酚可使呼吸和循环抑制程度减轻。缓慢注射丙泊酚优势限于减轻呼吸抑制和血压波动,但无法改善其他不良反应。Objective This study was to compare anesthetic effects of propofol at two injection rates on patients undergoing artificial abortion.Methods Sixty patients undergoing elective abortion were randomly assigned into two groups,with thirty in each.Patients were intravenously anesthetized with propofol(3.0 mg/kg)at either fast(10 sec)or slow(30 sec)injection rate.Anesthetic efficacy was observed,including onset time,resuscitation latency,injection pain,body movement,respiratory depression,cardiovascular inhibition,and postoperative adverse effects.Results Injection of propofol at slow rate took more time to induce unconsciousness in the patients,as compared to injection at fast rate(59.0±17.1 vs 39.2±13.8 sec,P<0.0001).However,there was no significant difference between two groups on the resuscitation latency(225.8±117.8 vs 279.9±119.1 sec,P=0.0821).Injection of propofol at slow rate induced less respiration depression,as compared to injection at fast rate(P=0.0084).Moreover,there were significantly smaller proportions of the patients at slow injection rate suffering oxygen desaturation below 95%[9(30.0%)vs 20(66.7%),P=0.0483]and necessitating respiratory assistance[1(3.3%)vs 6(20.0%),P=0.0444].In addition,there was significantly less patients at slow injection rate experiencing the decline of systolic blood pressure over 20%of baseline.Finally,there were no significant differences between two groups in other adverse effects.Conclusion Injection of propofol at a relatively fast rate could save time during anesthetic induction,whereas injection of propofol at a relatively slow rate could alleviate respiration depression and decline of blood pressure.The advantage of slow injection is limited to less respiration and cardiovascular inhibition,but not in other aspects.

关 键 词：人工流产 丙泊酚 注射速度 呼吸抑制 循环抑制 

分 类 号：R713[医药卫生—妇产科学]