羟考酮复合异丙酚用于门诊人工流产术最适剂量的临床探索-现代医学

羟考酮复合异丙酚用于门诊人工流产术最适剂量的临床探索

单位：上海市中医药大学附属曙光医院麻醉科, 上海 201203

分类号：R713.41

出版年·卷·期（页码）：2017·36·第四期（499-503）

摘要：

目的：探讨羟考酮复合异丙酚用于人工流产术的最适宜剂量。方法：选取2014年10月至2015年10月就诊于我院的250例行人工流产术患者，随机均分为5组各50例。异丙酚组（A组）静脉注射异丙酚1 mg·kg^-1，不同剂量羟考酮组（B、C、D、E组）在A组基础上分别静脉注射羟考酮20、50、100、150 μg·kg^-1，待患者睫毛反射现象消失后即开始手术。比较各组宫缩痛程度、呼吸循环及不良反应情况。结果：与术后30 min时的疼痛数字评分（NRS）比较，A组术后1、4 h时的NRS评分升高（P<0.05）；术后30 min，B、C、D、E组患者NRS评分均显著高于A组（P<0.05），并且B、C组患者NRS评分显著高于D、E组（P<0.05）。术后1 h，D、E两组患者NRS评分显著低于A、B、C 3组（P<0.05）。术后4 h，B、C、D、E组患者NRS评分均显著低于A组（P<0.05），C组患者NRS评分显著高于B、D、E 3组，差异具有统计学意义（P<0.05）。与其他组比较，E组患者在术中的平均动脉压（MAP）明显升高，但血氧饱和度（SpO₂）降低（P<0.05），其余4组之间MAP、SpO₂比较差异无统计学意义（P>0.05）；所有患者的心率（HR）、呼吸频率（RR）在不同组间比较差异均无统计学意义（P>0.05）。与其他组比较，E组患者的呼吸停顿、呼吸抑制、辅助呼吸发生率明显增加（P<0.05），其余4组术中不良反应发生率比较差异无统计学意义（P>0.05）；各组患者术后不良反应发生率比较差异无统计学意义（P>0.05）。结论：20 μg·kg^-1的羟考酮复合异丙酚对人工流产患者术后宫缩痛的镇痛效果较好，对呼吸循环的影响较小，术中及术后不良反应的发生率较低，患者术后恢复快。

Objective: To explore the optimal dosage of oxycodone combined with propofol on outpatient induced abortion.Methods: 250 cases of artificial abortion patients in our hospital were chosen from October 2014 to October 2015, and randomly divided into 5 groups. Patients in group A just intravenous propofol for 1 mg·kg^-1, the different doses of oxycodone groups (B, C, D, E group) were intravenously injected with intravenous oxycodone for 20,50,100,150 μg·kg^-1 on the basis of A group. The operation was started when patients' eyelash reflex disappeared. Compared with the degree of uterine contraction, respiration and circulation and adverse reactions among the groups.Results: Compared with NRS score at 30 min after the operation, the NRS score of A group increased at 1,4 h after operation(P<0.05); 30 min after the operation, the NRS score ofB, C, D, E groups were significantly higher than that in group A (P<0.05), and the NRS score of B, C groups were significantly higher than D, E groups (P<0.05). Postoperative 1 h later, the NRS score of D, E groups were significantly lower than the other three groups (P<0.05). Postoperative 4 h later, the NRS score ofB, C, D, E groups were significantly lower than that in group A (P<0.05), the NRS score of C group was significantly higher than B, D, Egroups, the difference were statistically significant (P<0.05). Compared with other groups, the MAP of patients in group E increased significantly, but the SpO₂ decreased (P<0.05), the difference of MAP and SpO₂ among the other four groups was not significant (P>0.05). Compared with other groups, the respiratory pause, respiratory inhibition and auxiliary respiratory rate of group Ewere significantly increased (P<0.05), and there was no significant difference in the incidence of adverse reactions among the other four groups (P>0.05).Conclusion: The analgesic effect of 20 μg·kg^-1 oxycodone combined with propofol on induced abortion uterine contraction painis better withless effect on respiration and circulation.The incidence of adverse reactions during and after operation is low, and the patients can postoperative recovery fast.

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