摘要目的 观察不同镇痛药物配伍丙泊酚静脉麻醉对无痛人工流产术后疼痛和情绪量值的影响.方法 选取行无痛人工流产术患者122例,按随机数字表法分为四组:单纯丙泊酚组(C组,29例)、芬太尼配伍丙泊酚组(F组,30例)、羟考酮配伍丙泊酚组(Q组,30例)和舒芬太尼配伍丙泊酚组(S组,33例).丙泊酚诱导剂量为2.5 mg/kg,患者术中出现四肢活动单次追加丙泊酚0.5 mg/kg至体动消失.比较四组手术前后平均动脉压(MAP)、心率和呼吸频率的变化.分别于术前和术后1 h进行情绪量表评分.苏醒后10、30和60 min采用视觉模拟量表(VAS)评估腹部疼痛程度.记录丙泊酚用量、手术时间、苏醒时间、不良反应等.结果 四组患者术中均未发生明显不良反应.四组手术时间比较差异无统计学意义(P>0.05).F组、Q组和S组丙泊酚用量、苏醒时间、体动反应和苏醒后10、30、60 min VAS评分均明显低于C组,差异有统计学意义(P<0.05);F组、Q组、S组比较差异无统计学意义(P>0.05).四组扩宫口和术中MAP、心率和呼吸频率明显低于麻醉前,差异有统计学意义(P<0.05);四组间各时间点MAP、心率和呼吸频率比较差异无统计学意义(P>0.05).C组、F组、Q组和S组术后正性情绪量值均明显高于术前[(24.6±5.6)分比(21.7±6.2)分、(24.6±3.1)分比(20.6±4.6)分、(28.3±6.3)分比(20.8±5.3)分和(25.2±5.4)分比(19.9±4.8)分],术后负性情绪量值均明显低于术前[(17.0±5.3)分比(29.7±7.4)分、(17.2±3.0)分比(30.8±5.0)分、(16.1±5.1)分比(30.4±4.9)分和(17.9±4.0)分比(32.1±5.5)分],差异有统计学意义(P<0.05);Q组术后正性情绪量值明显高于C组、F组和S组,差异有统计学意义(P<0.05);四组术后负性情绪量值比较差异无统计学意义(P>0.05).结论 芬太尼、舒芬太尼和羟考酮配伍丙泊酚静脉麻醉用于无痛人工流产术可以减少丙泊酚用量、缩短苏醒时间、提高正性情绪量值并降低负性情绪量值、增强术中和术后镇痛作用的同时并没有增加相关不良反应.不同阿片类药物配伍丙泊酚静脉麻醉对患者呼吸循环的抑制程度相似,但羟考酮提高正性情绪量值的作用明显,羟考酮配伍丙泊酚静脉麻醉能够在增强术中和术后镇痛的同时促进患者术后的身心健康.

abstractsObjective To evaluate the effects of different analgesics combined with propofol of intravenous anesthesia on postoperative analgesia and emotion in patients of artificial abortion. Methods One hundred and twenty-two patients who had underwent painless artificial abortion were selected. The patients were divided into 4 groups by random digits table method: simple propofol group (C group, 29 cases), fentanyl combined with propofol group (F group, 30 cases), oxycodone combined with propofol group (Q group, 30 cases) and sufentanil combined with propofol group (S group, 33 cases). The induced dose of propofol was 2.5 mg/kg. When patients had limb movement during operation, a single addition of propofol 0.5 mg/kg was added until the body movement disappeared. The changes of mean arterial pressure (MAP), heart rate and respiratory rate before and after operation were compared among the 4 groups. The emotional status was assessed with affective scale before operation and 1 h after operation. The visual analog scale (VAS) was used to evaluate the degree of abdominal pain at 10, 30 and 60 min after palinesthesia. The propofol dose, operation time, recovery time and adverse reaction were recorded. Results No obvious adverse reactions were found during the operation. There was no statistical difference in operation time among 4 groups (P>0.05). The propofol dose, recovery time, body movement and the VAS score at 10, 30, 60 min after palinesthesia in F group, Q group and S group were significantly lower than those in C group, and there were statistical differences (P<0.05);but there were no statistical difference among F group, Q group and S group (P>0.05). The MAP, heart rate and respiratory rate at beginning of the surgery and during the surgery were significantly lower than that before anesthesia in the 4 groups, and there were statistical differences (P<0.05); but there were no statistical differences in MAP, heart rate and respiratory rate among 4 groups (P>0.05). The positive affective score after operation in C group, F group, Q group and S group was significantly higher than that before operation: (24.6 ± 5.6) scores vs. (21.7 ± 6.2) scores, (24.6 ± 3.1) scores vs. (20.6 ± 4.6) scores, (28.3 ± 6.3) scores vs. (20.8 ± 5.3) scores and (25.2 ± 5.4) scores vs. (19.9 ± 4.8) scores, and the negative affective score after operation in C group, F group, Q group and S group was significantly lower than that before operation: (17.0 ± 5.3) scores vs. (29.7 ± 7.4) scores, (17.2 ± 3.0) scores vs. (30.8 ± 5.0) scores, (16.1 ± 5.1) scores vs. (30.4 ± 4.9) scores and (17.9 ± 4.0) scores vs. (32.1 ± 5.5) scores, and there were statistical differences (P<0.05). The positive affective score after operation in Q group was significantly higher than that in C group, F group and S group, and there was statistical difference (P<0.05). There was no statistical difference in negative affective score after operation among 4 groups (P>0.05). Conclusions The fentanyl, sufentanil and oxycodone combined with propofol of intravenous anesthesia in patients underwent artificial abortion can reduce propofol dose, shorten recovery time, improve positive affective score, decrease negative affective score and strengthen the analgesic effect, and doesn't increase the adverse reaction. The respiratory and circulatory inhibition effects of different analgesics combined with propofol of intravenous anesthesia were similar, but oxycodone can increase positive affective score.