两种方法用于人工流产镇痛效果临床比较研究.docVIP

两种方法用于人工流产镇痛效果的临床比较研究 　　【摘要】 目的 比较盐酸哌替啶、异丙嗪、芬太尼联合利多卡因(试验组)与丙泊酚联合芬太尼(对照组)用于人工流产术中的临床镇痛效果。方法 将480例自愿选择人工流产术的早孕妇女分为试验组与对照组,每组各240例,观察两组的镇痛效果、术中出血量,呼吸、循环抑制情况,人工流产综合征发生率及药物副反应等。结果 两组均取得良好的镇痛效果,但对照组呼吸、循环抑制的发生率明显高于试验组。结论 盐酸哌替啶、异丙嗪、芬太尼联合利多卡因用于人工流产术中镇痛效果好,且较丙泊酚联合芬太尼更安全。 　　【关键词】人工流产;盐酸哌替啶;异丙嗪;芬太尼;利多卡因;丙泊酚 　　 　　Comparison of clinical analgesic effects of two methods in artificial abortion 　　LIN Bai qing,CHEN Yan,ZENG Xiao hui.Department of Gynecology and Obstetrics,Fuzhou Eighth Hospital,Fuzhou 350013,China 　　【Abstract】 Objective To compare clinical analgesic effects of administration of combination of pethidine,promethazine,fentanyl and lidocaine with combination of propofol and fentanyl in artificial abortion.Methods 480 pregnant women undertook artificial abortion were divided equally into two groups.Analgesic effects,hemorrhage volume during operation,respiration and circulation depression,incidence of artificial abortion syndrome and side effects of drugs were observed for each group.Results Good analgesic effects were achieved in both groups.However,incidence of respiration and circulation depression was much higher in control group.Conclusion Administration of combination of pethidine,promethazine,fentanyl and lidocaine has good analgesic effects in artificial abortion.It’s also safer than administration of combination of propofol and fentanyl. 　　【Key words】Artificial abortion; Pethidine; Promethazine; Fentanyl; Lidocaine; Propofol 　　 　　人工流产术是避孕失败的一项补救措施,为提高手术质量,减少受术者的痛苦,近年术中广泛采用丙泊酚联合芬太尼镇痛,镇痛效果良好[1,2]。但由于丙泊酚需要在麻醉科医生的监护下使用,所需费用较高[2],为减轻患者的经济负担,我院近来探讨采用盐酸哌替啶、异丙嗪、芬太尼联合利多卡因用于人工流产术中的镇痛,取得良好疗效,现报告如下。 　　1 资料与方法 　　1.1 一般资料 选择2008年3月至2009年11月在我院行人工流产术的早孕妇女480例,年龄18~30岁,停经40~70 d,孕次1~4次,无人工流产禁忌证及药物、食物过敏史。根据患者自愿选择分为试验组(盐酸哌替啶、异丙嗪、芬太尼联合利多卡因麻醉)及对照组(丙泊酚联合芬太尼麻醉),每组240例。两组妇女的年龄、孕次、孕周差异无统计学意义(P0.05),见表1。 　　1.b 方法 术前禁食4~6 h,两组均于术前2 h舌下含服米索前列醇400μg。麻醉开始前两组均建立静脉通路,并常规心电监护,监测氧饱和度(SpO?2)、心率(HR)、血压(Bp)、呼吸(RR)。试验组于术前20 min静脉推注生理盐水10 ml+盐酸哌替啶50 mg+异丙嗪25 mg,术前10 min及5 min各静脉推注芬太尼0.05