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| 不同阿片类药物复合丙泊酚在宫腔镜手术中的比较 |
| Comparison of different opioids combined with propofol in hysteroscopic surgery |
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| DOI：10.12089/jca.2025.08.006 |
| 中文关键词: 丙泊酚 阿芬太尼 布托啡诺 舒芬太尼 宫腔镜手术 |
| 英文关键词: Propofol Alfentanil Butorphanol Sufentanil Hysteroscopic surgery |
| 基金项目:江苏省老年健康科研课题项目（LKM2022036） |
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| 摘要点击次数: 2014 |
| 全文下载次数: 576 |
| 中文摘要: |
目的： 观察和比较阿芬太尼、布托啡诺以及舒芬太尼复合丙泊酚用于宫腔镜手术的镇痛、镇静效果及对患者术后恢复的影响。
方法：选择择期行无痛宫腔镜手术女性患者150例，年龄18～55岁，BMI 18.5～28.0 kg/m2，ASA Ⅰ或Ⅱ级。采用随机数字表法将患者分为三组：阿芬太尼10 μg/kg（A组）、布托啡诺20 μg/kg（B组）和舒芬太尼0.1 μg/kg（S组），每组50例。给予镇痛药物后，每组静脉注射丙泊酚2 mg/kg。待患者睫毛反射消失后开始宫腔镜操作。记录术中低血压、心动过缓、呼吸抑制和呛咳及术后恶心呕吐、头晕、头痛等发生情况。记录入室时、扩张宫颈时、置入宫腔镜时、手术结束时的HR、MAP、SpO2。记录术中丙泊酚的诱导剂量、单位时间追加剂量和总量、术后睁眼时间、清醒时间、术后15 min、2和6 h的VAS疼痛评分。
结果：与入室时比较，A、B组扩张宫颈时、置入宫腔镜时、手术结束时HR明显减慢、MAP、SpO2均明显下降，S组扩张宫颈时、置入宫腔镜时、手术结束时HR明显减慢、MAP均明显下降，置入宫腔镜时以及手术结束时SpO2明显下降（P＜0.05）。与A组比较，B组和S组的术后恶心呕吐发生率明显升高，B组术后头晕和术后头痛发生率和术后15 min VAS疼痛评分明显升高，S组术后2和6 h VAS评分明显升高（P＜0.05）。与B组比较，S组的术后恶心呕吐和术后头晕的发生率明显降低，术后6 h VAS疼痛评分明显升高，A组和S组睁眼时间和清醒时间明显缩短（P＜0.05）。
结论：与布托啡诺和舒芬太尼复合丙泊酚比较，阿芬太尼复合丙泊酚用于宫腔镜手术对术中循环影响较小，且术后患者恢复清醒时间短，术后恶心呕吐等不良反应发生率更低。 |
| 英文摘要: |
Objective: To investigate the analgesic and sedative effects of alfentanil, butorphanol, and sufentanil combined with propofol in hysteroscopic surgery, as well as their impact on postoperative recovery.
Methods: A total of 150 female patients undergoing elective painless hysteroscopy were enrolled, aged 18 to 55 years, BMI 18.5-28.0 kg/m2, ASA physical status Ⅰ or Ⅱ. Patients were randomly assigned to three groups using a random number table: alfentanil 10 μg/kg (group A), butorphanol 20 μg/kg (group B), and sufentanil 0.1 μg/kg (group S), 50 patients in each group. After administration of the analgesic drugs, propofol 2 mg/kg was administered intravenously in each group. The hysteroscopic procedure was initiated after confirming the loss of the eyelash reflex. Intraoperative adverse events (hypotension, bradycardia, respiratory depression, or coughing) and postoperative complications (nausea / vomiting, dizziness, headache) were recorded. HR, MAP, and SpO2 were recorded upon entering the operating room, during cervical dilation, during hysteroscope insertion, and at the end of the operation. The induction dose, additional dose per unit time, and total dose of propofol used during the operation were also recorded. Postoperative eye-opening time and time to full awakening were documented. VAS pain scores were recorded at 15 minutes, 2 and 6 hours after the operation.
Results: Compared with baseline values upon entering the operating room, HR, MAP, and SpO2 were significantly decreased during cervical dilation, hysteroscope insertion, and at the end of the operation in groups A and B, HR and MAP were significantly decreased during cervical dilation, hysteroscope insertion, and at the end of the operation, while SpO2 were significantly decreased specifically during hysteroscope insertion and at the end of surgery in group S (P < 0.05). Compared with group A, the incidence of postoperative nausea and vomiting was significantly higher in groups B and S, the incidence of postoperative dizziness and postoperative headache in group B, as well as the VAS pain score at 15 minutes after surgery, were significantly higher, the VAS pain scores at 2 and 6 hours after surgery in group S were also significantly higher (P < 0.05). Compared with group B, the incidence of postoperative nausea, vomiting and postoperative dizziness in group S was significantly reduced, and the VAS pain score at 6 hours after surgery was significantly increased, the eye-opening time and awakening time in groups A and S were significantly shortened (P < 0.05).
Conclusion: Compared with butorphanol and sufentanil combined with propofol, alfentanil combined with propofol in hysteroscopic surgery results in fewer intraoperative hemodynamic fluctuations, shorter postoperative recovery times, and lower incidences of adverse reactions such as postoperative nausea and vomiting. |
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