丙泊酚及其与不同阿片类药物配伍在无痛人流术中的麻醉效果和满意度比较

发布时间：2018-03-16 16:10

本文选题：人工流产　切入点：丙泊酚　出处：《中南大学》2014年硕士论文　论文类型：学位论文

【摘要】：目的：本文通过观察丙泊酚及其丙泊酚复合芬太尼、舒芬太尼、瑞芬太尼在无痛人工流产术中麻醉效果及满意度的比较,探讨一种更安全高效舒适的麻醉方法,以满足无痛人流术的需要,为临床麻醉工作提供相关依据。方法：随机选择长沙市四医院门诊自愿采用无痛方式终止妊娠的早孕妇女400例, ASAⅠ-Ⅱ级,年龄17-35岁,体重43-60kg,均为第一次人流,无阴道生育史,术前经妇产科相关检查及B超确诊为宫内妊娠(42-68d),患者血液分析、出凝血时间及心电图无明显异常,无药物过敏史,无心肺功能障碍,无精神障碍及外伤手术史。将400例患者随机双盲分成4组：单纯丙泊酚复合生理盐水组(A组)、丙泊酚复合芬太尼组(B组)、丙泊酚复合舒芬太尼组(C组),丙泊酚复合瑞芬太尼组(D组),每组均100例。连接多功能监测仪,监测袖带血压(BP)、心电(ECG)、心率(HR)、脉搏血氧饱和度(Sp02)。消毒铺巾后,分别给予四组麻醉药,记录四组患者麻醉前、麻醉后2min,扩宫时、手术后1min的MAP、HR、和Sp02,记录苏醒时间及离院时间、腹痛(子宫收缩痛)的程度记录VAS分值、丙泊酚总用量、术中体动,术后三天内电话回访患者对麻醉的满意度及术毕调查手术者的麻醉满意度,总结得出各组数据,通过对所得数据的处理,分析得出实验结果。结果：400例入选患者其中有12例因术中出血多注射缩宫素、手术时间长、要求自动退出而被排除于本实验,共388例患者完成实验。 1、四组患者年龄、体重、孕龄及手术时间方面比较,均无统计学差异(P0.05)。 2、四组患者苏醒时间比较：A组苏醒时间显著延长(P0.05),而B组、C组和D组之间比较则无统计学差异(P0.05)。四组间离院时间比较：A组离院时间显著长于其他三组(P0.05),C组比较于B组和D组,离院时间明显短于B、D组(P0.05)。 3、观察术后10分钟四组VAS评分发现,比较于B、C、D组,A组术后VAS评分显著高于其他三组(P0.05)；而与B、C、D组比较,C组术后VAS评分明显低于B、D组(P0.05)。 4、电话调查四组患者对麻醉满意度比较：表示A组分别同B、C、D组比较,有统计学差异(P0.05)。C组与B、D组比较,有统计学差异(P0.05)。 5、术毕调查手术医生对麻醉满意度比较：表示A组分别同B、C、D组比较,有统计学差异(P0.05)。C组与B、D组比较,有统计学差异(P0.05)。 6、四组患者组间比较麻醉前(T1)MAP、HR、Sp02组间比较无明显差异(P0.05)。MAP和HR在四组患者麻醉后同时间点(T2、T3、T4)组间比较,无统计学差异(PO.05)。SP02在T3和T4时间点组间比较,无统计学差异(P0.05),在T2时间点,D组SP02显著低于其他三组(P0.05)。四组患者组内比较MAP、HR和SP02均在T2时间点出现下降,有统计学差异意义(P0.05),T3和T4时间点,MAP、HR和SP02的变化与T1比较无统计学差异(P0.05)。 7、四组丙泊酚用量比较,A组丙泊酚用量最大,A和B、C、D组比较均有统计学差异(P0.05),D组与B、C组比较,有统计学差异(P0.05) 8、四组间术中体动：A组较B、C、D组体动发生率高,有统计学差异(p0.05),C组与B、D比较,体动发生率明显低(p0.05)。结论结合苏醒时间、离院时间、术后腹痛(子宫收缩痛)程度、患者及手术医生对麻醉满意度等方面,舒芬太尼复合丙泊酚用于无痛人流手术的离院时间短,麻醉镇痛效果好,能有效地抑制人工流产术后的子宫收缩痛,术中生命体征较平稳,尤其是患者及手术医生满意度高等优点,充分提高了医院的经济效益和社会效益,是无痛人流手术最舒适、高效的麻醉药物配伍。
[Abstract]:Objective: through the observation of propofol and propofol combined with fentanyl, sufentanil, remifentanil anesthesia effect and satisfaction in painless artificial abortion, to explore a more comfortable safe and efficient method of anesthesia, in order to meet the needs of painless abortion, and to provide evidence for clinical anesthesia.
Methods: randomly selected four Changsha hospital outpatient painless way by voluntary termination of pregnancy in 400 cases of pregnant women, ASA I-II, age 17-35 years old, weight 43-60kg, were the first abortion, vaginal birth history, preoperative gynecology examination and ultrasound diagnosed intrauterine pregnancy (42-68d) patients. Blood analysis, blood coagulation time and ECG showed no abnormalities, no history of drug allergy, no pulmonary dysfunction, without mental disorders and trauma surgery. 400 patients were randomly divided into 4 groups: Propofol compound saline group (A group), propofol and fentanyl group (group B), propofol sufentanil group (group C), propofol and remifentanil group (D group), each group had 100 cases. The connection function monitor, monitoring cuff blood pressure (BP), electrocardiogram (ECG), heart rate (HR), pulse oxygen saturation (Sp02). After disinfection shop towels, four groups were given anesthetic records Four groups of patients before anesthesia, 2min after anesthesia, expanding palace, MAP, 1min after HR, and Sp02, recorded the recovery time and hospital stay time, abdominal pain (uterine contraction pain) degree recorded VAS score, total dosage of propofol, dynamic operation, three days after operation, the patient satisfaction on the telephone visit investigation of surgery and postoperative anaesthesia anesthesia satisfaction, summarize the data of each group, according to the data, analyze the experimental results.
Results: of the 400 selected patients, 12 of them were injected with oxytocin for operation bleeding, and the operation time was long. Automatic withdrawal was excluded from this experiment. A total of 388 patients completed the experiment.
1, there was no statistically significant difference in age, weight, gestational age and operation time between the four groups (P0.05).
2, the recovery time were compared between the four groups: A group significantly prolonged recovery time (P0.05), and B group, between C group and D group were not statistically significant (P0.05) between the four groups: A group from hospital time from hospital time was significantly longer than the other three groups (P0.05), C group compared to B group and D group, the hospital stay time was significantly shorter in the B group, D (P0.05).
3, 10 minutes after operation, four groups of VAS scores were found. Compared with group B, C and D, the VAS score in group A was significantly higher than that in the other three groups (P0.05), but compared with B, C and D group, the postoperative scores of C in the C group were significantly lower than those in group B (group B).
4, telephone survey of four groups of patients compared the satisfaction degree of anesthesia: A group and B, C, D group had statistical difference (P0.05).C group compared with B and D group, there was a significant difference (P0.05).
5, the operative satisfaction was compared between the two groups: the A group was statistically different from the B group, the C group and the D group (P0.05). There was a significant difference between the.C group and B group and D group (P0.05).
6, comparison of four groups of patients before anesthesia group (T1) MAP, HR, no significant difference between groups Sp02 (P0.05).MAP and HR at the same time in four groups of patients after anesthesia (T2, T3, T4) between the two groups, no statistical difference (PO.05) between.SP02 and T4 at T3 time point between groups, no statistical differences (P0.05), at the time point of T2, D in group SP02 was significantly lower than the other three groups (P0.05). The four groups were compared within the group of MAP, HR and SP02 appeared at T2 time point decreased, there was significant difference significance (P0.05), T3 and T4 time point, MAP, change with T1 HR and SP02 had no statistical difference (P0.05).
7, four groups of propofol was compared, A group propofol dosage was the largest, A and B, C, D group compared statistically significant difference (P0.05), D group and B, C group, there is a statistical difference (P0.05).
8, four groups of intraoperative body movement: group A was higher than B, C, D group, and there was a statistically significant difference (P0.05). Group C was compared with B, D, and the rate of body movement was significantly lower (P0.05).
Conclusion the combination of recovery time, leave hospital time, postoperative abdominal pain (uterine contraction pain), patients and surgeons on anesthesia satisfaction, sufentanil and propofol for painless surgery from the hospital a short time, the analgesic effect is good, can effectively inhibit uterine contraction pain after artificial abortion, intraoperative vital signs more stable, especially higher in patients and doctors' satisfaction advantages, and fully improve the hospital economic benefit and social benefit, is the most comfortable and painless surgery, sedations efficient.

【学位授予单位】：中南大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R614

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