本文選題：人工流產(chǎn)　切入點：丙泊酚　出處：《中南大學(xué)》2014年碩士論文　論文類型：學(xué)位論文

【摘要】：目的：本文通過觀察丙泊酚及其丙泊酚復(fù)合芬太尼、舒芬太尼、瑞芬太尼在無痛人工流產(chǎn)術(shù)中麻醉效果及滿意度的比較,探討一種更安全高效舒適的麻醉方法,以滿足無痛人流術(shù)的需要,為臨床麻醉工作提供相關(guān)依據(jù)。 方法：隨機選擇長沙市四醫(yī)院門診自愿采用無痛方式終止妊娠的早孕婦女400例, ASAⅠ-Ⅱ級,年齡17-35歲,體重43-60kg,均為第一次人流,無陰道生育史,術(shù)前經(jīng)婦產(chǎn)科相關(guān)檢查及B超確診為宮內(nèi)妊娠(42-68d),患者血液分析、出凝血時間及心電圖無明顯異常,無藥物過敏史,無心肺功能障礙,無精神障礙及外傷手術(shù)史。將400例患者隨機雙盲分成4組：單純丙泊酚復(fù)合生理鹽水組(A組)、丙泊酚復(fù)合芬太尼組(B組)、丙泊酚復(fù)合舒芬太尼組(C組),丙泊酚復(fù)合瑞芬太尼組(D組),每組均100例。連接多功能監(jiān)測儀,監(jiān)測袖帶血壓(BP)、心電(ECG)、心率(HR)、脈搏血氧飽和度(Sp02)。消毒鋪巾后,分別給予四組麻醉藥,記錄四組患者麻醉前、麻醉后2min,擴宮時、手術(shù)后1min的MAP、HR、和Sp02,記錄蘇醒時間及離院時間、腹痛(子宮收縮痛)的程度記錄VAS分值、丙泊酚總用量、術(shù)中體動,術(shù)后三天內(nèi)電話回訪患者對麻醉的滿意度及術(shù)畢調(diào)查手術(shù)者的麻醉滿意度,總結(jié)得出各組數(shù)據(jù),通過對所得數(shù)據(jù)的處理,分析得出實驗結(jié)果。 結(jié)果：400例入選患者其中有12例因術(shù)中出血多注射縮宮素、手術(shù)時間長、要求自動退出而被排除于本實驗,共388例患者完成實驗。 1、四組患者年齡、體重、孕齡及手術(shù)時間方面比較,均無統(tǒng)計學(xué)差異(P0.05)。 2、四組患者蘇醒時間比較：A組蘇醒時間顯著延長(P0.05),而B組、C組和D組之間比較則無統(tǒng)計學(xué)差異(P0.05)。四組間離院時間比較：A組離院時間顯著長于其他三組(P0.05),C組比較于B組和D組,離院時間明顯短于B、D組(P0.05)。 3、觀察術(shù)后10分鐘四組VAS評分發(fā)現(xiàn),比較于B、C、D組,A組術(shù)后VAS評分顯著高于其他三組(P0.05)；而與B、C、D組比較,C組術(shù)后VAS評分明顯低于B、D組(P0.05)。 4、電話調(diào)查四組患者對麻醉滿意度比較：表示A組分別同B、C、D組比較,有統(tǒng)計學(xué)差異(P0.05)。C組與B、D組比較,有統(tǒng)計學(xué)差異(P0.05)。 5、術(shù)畢調(diào)查手術(shù)醫(yī)生對麻醉滿意度比較：表示A組分別同B、C、D組比較,有統(tǒng)計學(xué)差異(P0.05)。C組與B、D組比較,有統(tǒng)計學(xué)差異(P0.05)。 6、四組患者組間比較麻醉前(T1)MAP、HR、Sp02組間比較無明顯差異(P0.05)。MAP和HR在四組患者麻醉后同時間點(T2、T3、T4)組間比較,無統(tǒng)計學(xué)差異(PO.05)。SP02在T3和T4時間點組間比較,無統(tǒng)計學(xué)差異(P0.05),在T2時間點,D組SP02顯著低于其他三組(P0.05)。四組患者組內(nèi)比較MAP、HR和SP02均在T2時間點出現(xiàn)下降,有統(tǒng)計學(xué)差異意義(P0.05),T3和T4時間點,MAP、HR和SP02的變化與T1比較無統(tǒng)計學(xué)差異(P0.05)。 7、四組丙泊酚用量比較,A組丙泊酚用量最大,A和B、C、D組比較均有統(tǒng)計學(xué)差異(P0.05),D組與B、C組比較,有統(tǒng)計學(xué)差異(P0.05) 8、四組間術(shù)中體動：A組較B、C、D組體動發(fā)生率高,有統(tǒng)計學(xué)差異(p0.05),C組與B、D比較,體動發(fā)生率明顯低(p0.05)。 結(jié)論結(jié)合蘇醒時間、離院時間、術(shù)后腹痛(子宮收縮痛)程度、患者及手術(shù)醫(yī)生對麻醉滿意度等方面,舒芬太尼復(fù)合丙泊酚用于無痛人流手術(shù)的離院時間短,麻醉鎮(zhèn)痛效果好,能有效地抑制人工流產(chǎn)術(shù)后的子宮收縮痛,術(shù)中生命體征較平穩(wěn),尤其是患者及手術(shù)醫(yī)生滿意度高等優(yōu)點,充分提高了醫(yī)院的經(jīng)濟效益和社會效益,是無痛人流手術(shù)最舒適、高效的麻醉藥物配伍。
[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.

【學(xué)位授予單位】：中南大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2014
【分類號】：R614

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