国际麻醉学与复苏杂志   2016, Issue (9): 6-6
    
羟考酮与舒芬太尼用于无痛人工流产术的镇痛效果比较
任达, 王大奇, 邱泽武, 李强1()
1.人民解放军301医院
Comparison of analgesic efficacy between oxycodone and sufentanil in painless induced abortion
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摘要:

目的 研究羟考酮注射液复合丙泊酚在无痛人工流产术中应用的有效性与安全性。 方法 采用随机数字表法将60例行无痛人工流产术患者分为3组(每组20例):丙泊酚与羟考酮组(A组),丙泊酚与舒芬太尼组(B组),丙泊酚与安慰剂组(C组)。记录3组麻醉诱导前(T1)、扩张宫颈时(T2)、苏醒即刻时(T3)的MAP、HR、SpO2,围手术期的副作用,T3、苏醒后30 min(T4)、苏醒后3.5 h(T5)的VAS评分,3组患者应用阿托品与间羟胺的次数与离院时间,并进行比较。 结果 3组患者一般资料及手术时间差异无统计学意义(P>0.05)。A组、B组的丙泊酚用量[(130±22)、(141±27) mg]与苏醒时间[(1.2±0.8)、(1.3±1.1) min]比C组[(164±40) mg和(2.6.±1.6) min]明显减少(P<0.01)。A组T2时的MAP与HR[(77±10) mmHg(1 mmHg=0.133 kPa)和(67±8) 次/min]比T1时[(88±8) mmHg和(78±12) 次/min]明显降低(P<0.01)。C组T2时的HR[(80±15) 次/min]比T1时[(74±7) 次/min]增加(P<0.05)。体动发生次数A组、B组比C组明显减少(P<0.01),头晕发生次数A组、B组比C组明显增加(P<0.01),且A组少于B组(P<0.05)。A组T3、T4、T5时的VAS评分明显低于C组(P<0.01),B组T3、T4时的VAS评分明显低于C组(P<0.01)。A组T3、T5时的VAS评分低于B组(P<0.05),尤其T5时更低(P<0.01)。3组之间的用药次数比较,差异无统计学意义(P>0.05)。C组的离院时间比A组、B组长(P<0.05)。 结论 丙泊酚联合羟考酮比丙泊酚联合舒芬太尼或单用丙泊酚在无痛人工流产术中具有更好的镇痛效果、更少的副作用,可安全、有效地用于无痛人工流产术。

关键词: 羟考酮; 舒芬太尼; 无痛人工流产术
Abstract:

Objective To assess the efficacy and safety of oxycodone injection in combination with propofol administered in painless induced abortion. Methods Based on random number tables, sixty patients were randomly divided into three groups(n=20): propofol and oxycodone group (group A), propofol and sufentanil group(group B), and propofol and placebo group (group C). MAP, HR, and SpO2 were recorded before anesthesia induction(T1), upon cervical dilatation(T2), and upon recovery time(T3). They also participated in the comparisons of perioperative side effects, VAS T3, thirty minutes after recovery(T4) and three and half hours after recover(T5), administered times of atropine and metaraminol, as well as the discharge time. Results Disparities in medical records and operative procedure time of the three groups had no statistical significance(P>0.05). In group A and B, the dose of propofol, (130±22) mg and (141±27) mg respectively, and recovery time, (1.2±0.8) min and (1.3±1.1) min respectively, showed marked decrease compared with group C, whose measurement of the two aspects stood at (164±40) mg and (2.6.±1.6) min(P<0.01). In group A, MAP and HR were measured at (88±8) mmHg(1 mmHg=0.133 kPa) and (78±12) bpm at T1, (77±10) mmHg and (67±8) bpm at T2, showing significant decrease(P<0.01). While in group C, HR registered an increase from(74±7) bpm at T1 to(80±15) bpm at T2(P<0.05). In terms of the rate of body dynamic response, group A and B showed considerable decrease compared with group C(P<0.01). Patients of group A and B suffered noticeably more dizziness than their group C counterparts(P<0.01), with group A faring better than group B (P<0.05). At T3, T4 and T5, group A's VAS were much lower than that of group C(P<0.01). The same thing happened at group B's T3 and T4 when its VAS scored significantly less than that of group C(P<0.01). At T3 and T5, group A's VAS were lower than that of group B(P<0.05), the gap of which was even wider at T5(P<0.01). Disparities in the times of medication administration of the three groups bore no statistical significance(P>0.05). Group C patients stayed longer in hospital than that of group A and B(P<0.05). Conclusions Among the three pain management methods, propofol combined with oxycodone, propofol in conjunction with sufentanil and independent dosing of propofol, the first regimen achieved the best efficacy along with fewer side effects, making it a safe and effective option for painless induced abortion.

Key words: Oxycodone; Sufentanil; Painless induced abortion