| Objective:In recent years, with the continuous improvement of economy and the demands of the development of the modern medical humane, the painless artificial abortion was acknowledged and accepted by more and more patients because of its minimal invasion,less bleeding, intraoperative unconscious, postoperative fast recovery, less risk of complications, high security and so on. But painless abortion technique itself did not reach the level of ideal, there were adverse reactions caused by respiratory inhibition and opioid, which made patients take some risks in the process of anaesthesia. Therefore, in order to make the painless abortion surgery anesthesia safer and more effective, this research used oxycodone hydrochloride injection and propofol in painless abortion application and compared its effect with sufentanil combined with propofol anesthesia and anesthesia with propofol alone to further explore more effective, safer and better anesthesia program in painless artificial abortion. Methods:Preparation before anaesthesia: before the operation, three groups of patients were not fed for more than 6 hours with no premedication. After entering the operating room, conventional opened veins of upper limb and input 5% glucose injection solution. And connect the CAM anesthesia monitor(Finland Finland GE Healthcare Finland oy) Andthen,continuously monitor the mean arterial pressure(MAP), the electrocardiogram(ECG) and oxygen saturation(Sp O2). At last, intake Oxygen(4L/min) byconnecting nasal cannula.60patients in painless abortion surgery were randomly divided into three groupsby random number table method: Group A was slowly intravenously injected oxycodone hydrochloride(0.1 mg / kg) 5 min before the surgery;Group Bwas slowly intravenously injectedsufentanil citrate(0.1 mg / kg) 5 min before the surgery;Group C was slowly intravenously injected0.9% physiological saline. All drugs were diluted to 5ml with 0.9% saline before operationand the injection time was more than 1min.5min after the drug injection, all groups were injected 1% propofol 2mg / kg and ondansetron hydrochloride 8mg.When patients had slight physical activity(jog hands or frown) during anesthesia, 1% propofol(20-30 mg) was injectedeach time. When patients’ heart rateswere less than 50 beats / min or less than 30% of baseline values, atropine sulfate(0.25-0.5mg) was intravenously injectedeach time.When patients’ blood pressure, MAP was less than 50 mm Hg(1 mm Hg = 0.133 k Pa) or below 30% of the baseline valuesmetaraminol bitartrate(0.25-0.5mg)was injected intravenously injection each time. When patients had respiratory depression(Sp O2 <90%), immediatelyput on the pressurized oxygen maskuntil the patient breathing steady(Sp O2> 98%) and then took the oxygen mask away, continuously use nasal oxygen catheter instead. In all operations anesthesia were performed by an anesthesiologist with a skilled gynecologist surgery. Surgery patients enteringthe recovery room were continuously observed. Indicationsof leaving the recovery room: full awaking, coughing, recovery of swallowing reflex, breathing air(Sp O2> 95%). Results:In this research, the amount of propofol used in Group A and Group Bwere(130.2±22.3mg)and(141.4±27.2mg); The time Group A and Group B took to wake were(1.2±0.8min)and(1.3±1.1min).Both wereless than the amount of propofol used in Group C(163.6±40.1mg)andthe time Group C took to wake(2.6.±1.6min)(p <0.01). It suggested that the recovery time is related to the dosage of propofol andusing high-dose propofol can easily cause recoverydelay.The MAP and HR of Group A in the time T2 were(77±10mm Hg)and(67±8bpm),The MAP and HR of Group A in the time T1 were(88±8mm Hg)and(78±12bpm)。Compared the two, thetwo quantities of Group A in T2 significantly decreased(p < 0.01)。The HR of Group C in T2 and T1 were(80±15bpm)and(74±7bpm),the HR of Group C in T2 increased(p < 0.05)。The frequencyof body movement in group A(5/20)and Group B(6/20)were muchless thanthat of group C(17/20)(p <0.01), The frequency of dizziness occurence in group A(10/20)ã€and Group B(18/20) were far more than that of group C(3/20)(p <0.01), and the dizziness occurred in group A was less than the group B(p <0.05). VAS scores of Group A atthe awakening time(1.2±0.8),30 min after the awakening time(0.9±0.6) and3.5hour after the awakening time(0.5±0.6) were significantly lower than those of Group B(p<0.05), and the VAS score 3.5hafter the awakening time changed more than the other two.(p <0.01). VAS scores of Group B at the awakening time(1.7±0.7)and 30 min after the awakening time(2.1±0.6)was lower than those of Group C at the awakening time(2.7±0.8)and 30 min after the awakening time-(2.1±0.6)(p <0.01). VAS scores of Group A at the awakening time(1.2±0.8)and 30 min after the awakening time(0.5±0.6) was lower than those of Group B at the awakening time(1.7±0.7)and 30 min after the awakening time-(1.5±0.9)(p <0.05) and the difference was more obvious 3.5 hours after the awakening time.(p <0.01)This suggested that both oxycodone hydrochloride group and sufentanil group did well in intraoperative analgesia and inhibition of sympathetic activity and body movement caused by intraoperative pain. But it also has adverse effects of opioid analgesics such as dizziness, nausea, vomiting, respiratory depression and so on. However, compared to those happened in sufentanil group, in oxycodone hydrochloride group,the inhibition of sympathetic nerve excitation caused by pain was stronger;theinhibition of pain itself was stronger, the time of inhibition last longer; and the incidence of adverse effects, for instance, dizziness was lower. This might be related to that oxycodone hydrochloride’s visceral analgesic effect was better than that of sufentanil and the clinical effects timeofoxycodone hydrochloride was longer than that of sufentanil. Conclusion:To sum up, The VAS analgesia score of using combined propofol with oxycodone hydrochloride in painless abortion was better than that of the combined propofol with sufentanil and that of propofol alone,and using combined propofol with oxycodone hydrochloridein painless abortion had fewer adverse reactions. That provedit could be safer and more effective applied in painless artificial abortion。... |
PDF Full Text Request