不同阿片受体激动拮抗剂联合丙泊酚用于人工流产手术的镇痛效果比较  

Comparison of analgesic effect of different opioid receptor agonist antagonists combined with Propofol in induced abortion

作　　者：徐佳明 周晓芳 郭建荣 XU Jiaming;ZHOU Xiaofang;GUO Jianrong(Postgraduate Training Base of Shanghai Gongli Hospital of Ningxia Medical University,Shanghai 200135,China;Department of Anesthesiology,Shanghai Pudong New District Gongli Hospital of Naval Medical University,Shanghai 200135,China)

机构地区：[1]宁夏医科大学上海公利医院研究生培养基地,上海200135 [2]海军军医大学附属上海浦东新区公利医院麻醉科,上海200135

出　　处：《妇儿健康导刊》2023年第1期15-18,31,共5页JOURNAL OF WOMEN AND CHILDREN'S HEALTH GUIDE

基　　金：上海市浦东新区卫生健康委员会卫生科技项目(PW2020A-17)。

摘　　要：目的探讨丙泊酚镇静作用下,人工流产术应用不同阿片受体激动拮抗剂对患者术后宫缩痛及意识状态的影响。方法选取2021年7月至12月上海浦东新区公利医院收治的156例拟行无痛人工流产术患者。按随机数字表法分为地佐辛组(D组)、纳布啡组(N组)和对照组(G组),每组各52例,分别于入室心电监护后给予地佐辛5 mg、纳布啡0.2 mg/kg、舒芬太尼0.1μg/kg,消毒铺巾后给予丙泊酚中/长链脂肪乳注射液1.5 mg/kg,待患者睫毛反射消失行人工流产手术。比较三组入室时、睫毛反射消失时、宫颈扩张时、手术结束时的平均动脉压、心率、脉搏血氧饱和度,记录三组患者的不良反应发生情况。分别于术毕15 min、术毕30 min和术毕1 h采用视觉模拟评分法(VAS)评价患者宫缩痛的程度以及进行Ramsay镇静评分。结果N组与D组在睫毛反射消失时、宫颈扩张时的平均动脉压较G组高(P<0.05)。N组VAS评分、不良事件总发生率低于其他两组(P<0.05)。N组Ramsay镇静评分高于G组、D组(P<0.05)。结论无痛人工流产术采用纳布啡联合丙泊酚静脉麻醉镇痛效果满意、不良反应少,但由于镇静程度较深,应注意术后苏醒期监护,此方案值得临床推广。Objective To investigate the effect of different opioid receptor agonist antagonists in induced abortion with Propofol sedation on postoperative contraction pain and state of consciousness.Methods A total of 156 patients admitted to Shanghai Pudong New District Gongli Hospital from July to December 2021 were selected for induced abortion.According to the random number table method,they were divided into Dezocine group(group D),Nalbuphine group(group N)and control group(group G),52 cases in each group.Routine monitoring was given after patients entering the room.The three groups were intravenously injected with 5 mg Dizocine,0.2 mg/kg Nalbuphine and 0.1μg/kg Sufentanil,respectively.After disinfection,1.5 mg/kg Propofol Medium and Long Chain Fat Emulsion Injection was given.When the patients’eyelash reflex disappeared,then induced abortion was performed.Mean arterial pressure,heart rate and pulse oxygen saturation of patients in the three groups were compared at the time of entry,at the absence of eyelash reflex,at the tim e of cervical dilation and at the end of s urgery,and adverse reactions of the three groups were recorded.Visual analogue scale(VAS)was used to evaluate the contraction pain.VAS and Ramsay sedation score were recorded at 15 min,30 min and 1 h after surgery,respectively.Results Mean arterial pressure of group N and group D were higher than those of group G at the absence of eyelash ref lex and at the time of cervical dilation(P<0.05).The VAS scores and total incidence of adverse events of group N were lower than those of the other two groups(P<0.05).Ramsay sedation score in group N was higher than that in group G and group D(P<0.05).Conclusion Induced abortion using Nalbuphine combined with Propofol intravenous anesthesia has satisfactory analgesic effect and few adverse reactions,which is worth promoting in clinical practice.But due to the deep degree of sedation,more attention should be paid to the postoperative recovery monitoring.

关 键 词：纳布啡 人工流产术 宫缩痛 丙泊酚 地佐辛 

分 类 号：R614.2[医药卫生—麻醉学]