复合丙泊酚时阿芬太尼抑制稽留流产清宫术扩宫痛的半数有效剂量  

Median effective infusion dose of alfentanil combined with propofol inhibiting dilation pain in curettage of missed abortion

作　　者：彭瑞 徐晨阳[1] 周蓉蓉 冯善武[1] 袁红梅[1] PENG Rui;XU Chenyang;ZHOU Rongrong;FENG Shanwu;YUAN Hongmei(Department of Anesthesiology,the Women's Hospital of Nanjing Medical University,Nanjing 210004,China)

机构地区：[1]南京医科大学附属妇产医院(南京市妇幼保健院)麻醉科,210004

出　　处：《临床麻醉学杂志》2023年第3期250-253,共4页Journal of Clinical Anesthesiology

基　　金：南京市妇幼保健院十四五“骨干人才”培养项目(宁妇委〔2021〕36号)。

摘　　要：目的评估复合丙泊酚时阿芬太尼抑制稽留流产清宫术扩宫痛的半数有效剂量(ED_(50))。方法选择择期全麻下行稽留流产清宫术患者29例,年龄24~45岁,孕期8~14周,BMI 18~28 kg/m^(2),ASAⅠ或Ⅱ级。采用改良序贯法进行研究。阿芬太尼初始用量为10μg/kg,静注时间不短于30 s,再给予丙泊酚1.5 mg/kg。判断患者意识与睫毛反射情况,待消失后进行稽留流产清宫术。手术期间,有体动则继续推注丙泊酚1 mg/kg。若扩宫痛阳性,下一例增加阿芬太尼用量;反之,则减少用量。增减梯度比为1∶1.2。扩宫痛阳性标准:扩宫时发生体动或出现痛苦表情。计算阿芬太尼抑制扩宫痛的ED_(50)、ED_(95)和95%可信区间(CI)。记录术中轻度低氧、中度低氧、重度低氧、心动过缓、低血压、呛咳,术后头痛、头晕、恶心、呕吐等不良反应发生情况。结果阿芬太尼抑制稽留流产清宫术疼痛的ED_(50)为7.4μg/kg(95%CI 4.0~9.3μg/kg),ED_(95)为11.5μg/kg(95%CI 9.5~37.5μg/kg)。29例患者术中无一例重度低氧、心动过缓、呛咳、呕吐,轻度低氧1例,中度低氧4例,给予托下颌后及时缓解。术后头晕2例,恶心3例。结论复合丙泊酚静脉麻醉时,阿芬太尼抑制稽留流产清宫术扩宫痛的ED_(50)为7.4μg/kg。Objective To determine median effective infusion dose(ED_(50))of alfentanil combined with propofol relieving dilation pain in curettage of missed abortion.Methods Twenty-nine patients,aged 24-45 years,in pregnant 8-14 weeks,BMI 18-28 kg/m^(2),in ASA physical statusⅠorⅡunderwent curettage of missed abortion in general anesthesia.The trial was carried out using the modified Dixon sequential method.The initial dose of alfentanil was 10μg/kg for at least 30 seconds,then propofol 1.5 mg/kg was administered.After comfirming that the patient's consciousness and eyelash-reflex were gone,missed abortion was performed.During the operation,propofol 1 mg/kg was added in case of somatic reaction.If the patient moved or frowned during the dilatation,the dose gradient of alfentanil was increased in the next case.On the contrary,one dose gradient was reduced.The dose was increased or decreased according to a gradient of 1∶1.2.Positive criteria of painful dilation was defined as body movements or expressions of pain during dilation.The ED_(50),ED_(95)and the corresponding 95%confidence interval(CI)of alfentanil inhibition of dilation pain were calculated.Mild hypoxia,moderate hypoxia,severe hypoxia,bradycardia,hypotension and choking,as well as headache,dizziness,nausea and vomiting were recorded.Results When combined with propofol,the ED_(50)of alfentanil for suppressing dilatation pain in curettage of missed abortion was 7.4μg/kg(95%CI 4.0-9.3μg/kg),and the ED_(95)was 11.5μg/kg(95%CI 9.5-37.5μg/kg).No severe hypoxia,bradycardia,choking or vomiting occurred in all patients.Mild hypoxia occurred in 1 patients.Moderate hypoxia occurred in 4 patients and quickly relieved with jaw support.Postoperative dizziness occurred in 2 patients and nausea in 3 patients.Conclusion The ED_(50)of alfentanil was 7.4μg/kg for suppressing painful dilation in missed abortion when combined with propofol.

关 键 词：阿芬太尼 丙泊酚 稽留流产清宫术 改良序贯法 半数有效剂量 

分 类 号：R614[医药卫生—麻醉学]