摘要
目的 探讨无痛人工流产术中患者体动发生的可能机制及其防治策略。方法 收集行人工流产手术的患者 4 5例 ,随机分为 3组 ,Ⅰ组予静脉注射异丙酚 2mg·kg-1·min-1,Ⅱ组予静脉注射芬太尼 1μg/kg +异丙酚 2mg·kg-1·min-1,Ⅲ组予静脉注射芬太尼 2 μg/kg +异丙酚 2mg·kg-1·min-1。采用HXD G型多功能监护仪监测心率变异性 (HRV) ,包括低频 (LF)、高频 (HF)、频比 (LF/HF)、总频率 (LF +HF) ;脑双频谱指数(BIS)、平均动脉压 (MAP)、心率 (HR)等 ,闭目安静 3min后记录各参数的基础值 ,分别记录用药后、负压吸引时、操作后 1、5、10、2 0min上述各参数的变化值 ,并在术后 2 0min进行镇静 /警觉 (OAA/S)评分 ,记录 3组异丙酚总用量和术中体动情况。结果 3组患者年龄、体重、异丙酚用量及术后 2 0minOAA/S评分差异均无显著性。与基础值相比 ,3组患者用药后及操作后 1minMAP明显下降 (P <0 .0 5 ) ,但组间比较差异无显著性。与Ⅰ、Ⅱ组相比 ,Ⅲ组用药后、负压吸引时及操作后 1～ 5minHR明显降低 (P <0 .0 5 )。 3组患者用药后BIS均显著降低 ,负压吸收时也无明显变化 ,组间比较差异无显著性。用药后HRV及其各频段参数均较基础值降低 ,尤以HRV、LF明显 (P <0 .0 1)。与Ⅰ、Ⅱ组相比 ,Ⅲ组的HRV及其LF、LF
Objective To study prospectively the changes of heart rate variability following intravenous propofol, and fentanyl combined propofol anesthesia during painless artificial abortion. Methods Forty five patients aged 18～38 years ,ASA gradeⅠ, scheduled for painless artificial abortion. Patients were randomly allocated into three groups( n =15): groupⅠreceived continuous intravenous propofol, group Ⅱ received intravenous administration of fentanyl 1 μg/kg 2 min before given propofol, group Ⅲ received intravenous administration of fentanyl 2 μg/kg 2 min before given propofol. Propofol infusion rate was 2 mg·kg -1 ·min -1 in all three groups,As BIS was close to 55±5, and the remaining 10 s before operation. In each groups HRV(LF, HF, LF/HF, LF+HF), BIS, MAP and HR parameters were recorded before induction and operation; during the operation and 1 min, 5 min, 10 min, 20 min after the operation. The total dose of propofol ,OAA/S scale 20 min after operation and restless moving were recorded during the operation.Results There were no differences in age, weight, total dose of propofol, OAA/S scale 20 min after operation among the groups. In the three groups MAP were lower after induction and 1 min after operation( P < 0.05 ),but there were no differences among them. Compared with that in groupⅠ and Ⅱ,HR in group Ⅲ decreased significantly after the induction, during the operation and 1～5 min after operation( P < 0.05 ). BIS decreased significantly after the induction and 1～5 min after operation( P < 0.05 ) and remained unchanged during the operation in the three groups. There were no differences among these groups.HRV with every spectrum was lower after induction in all three groups ( P < 0.05 ), especially HRV, LF( P < 0.01 ). Comparing with those in groupⅠandⅡ, HRV, LF and LF+HF in group Ⅲ were lower during the operation and 1～5 min after operation( P <0.05 and P <0.01). The records before induction showed HF in all three groups increased significantly 5,10,20 min after operation( P <0.05). There were no differences among groups in the total dose of propofol, OAA/S scale 20 min after the operation. Compared with that in group Ⅰ and Ⅱ,restless moving in group Ⅲ decreased significantly during the operation ( P =0.00426).Conclusion Fentanyl 2 μg/kg inhibit significantly the excitation of sympatheti adrenal and sympathetic adrenomedullary system and reduce the restless moving during painless artificial abortion induced by intravenous poprofol, but does not delay the significant resurrection.
出处
《上海医学》
CAS
CSCD
北大核心
2003年第3期204-207,共4页
Shanghai Medical Journal
