摘要
目的探讨肥胖患者在无痛人工流产(人流)时使用不同剂量丙泊酚诱导的安全性。方法 60例行择期无痛人工流产手术的肥胖患者,随机分为对照组和实验组,各30例。对照组诱导时丙泊酚的量=实际体质量(kg)×2.0 mg/kg,麻醉维持时丙泊酚的量=实际体质量(kg)×0.5 mg/kg,实验组诱导时丙泊酚的量=理想体质量(kg)×2.0 mg/kg,麻醉维持时丙泊酚的量=理想体质量(kg)×0.5 mg/kg,观察并记录注药前(T_1)、睫毛反射消失时(T_2)、手术开始时(T_3)、术毕(T_4)及清醒时(T_5)的平均动脉压(MAP)、血氧饱和度(Sp O_2)、心率(HR);两组术中呼吸抑制发生率[呼吸频率(RR)<8次/min或吸氧时Sp O_2<93%]术中体动发生情况,清醒时间[改良警觉镇静评分标准(MOAA/S)评分4~5分];术后镇痛效果:用视觉模拟评分法(VAS)评分评估患者清醒后10、30 min的疼痛程度;记录恶心呕吐等不良反应的发生情况。结果实验组T_2、T_3、T_4的MAP、Sp O_2、HR优于对照组,差异有统计学意义(P<0.05)。实验组呼吸抑制率16.67%低于对照组的73.33%,差异有统计学意义(P<0.05)。实验组清醒时间短于对照组,差异有统计学意义(P<0.05)。两组恶心呕吐发生率比较差异无统计学意义(P>0.05)。结论肥胖患者行无痛人工流产手术时,诱导时丙泊酚的量=理想体质量(kg)×2.0 mg/kg,麻醉维持时丙泊酚的量=理想体质量(kg)×0.5 mg/kg,安全性大大提高。
Objective To discuss the safety of of propofol induction in obese patients. Methods A total of 60 obese patients undergoing selected painless abortion were randomly divided into control group and experimental group, with 30 cases in each group. The control group had propofol for induction = actual body mass （kg） × 2.0 mg/kg, and propofol for maintenance = actual body mass （kg） × 0.5 mg/kg, while the experimental group had propofol for induction = ideal body mass （kg） × 2.0 mg/kg, and propofol for maintenance = ideal body mass （kg） × 0.5 mg/kg. Observation and record were made on mean arterial pressure （MAP）, oxygen saturation （SpO2）, heart rate （HR） at before injection （T1）, eyelash reflex disappearing （T2）, at the beginning of the operation （T3）, after operation （T4） and awake （Ts）, incidence of intraoperative respiratory depression [ respiratory rate （RR）〈8 times/rain or SpO2 〈 93% when oxygen inhalation ] , intraoperative body movement, awake time [ modified observer＇ s assessment of alertness/sedation （MOAA/S） score as 4-5 points ] , postoperative analgesic effect, pain degree of 10, 30 min after sobriety by visual analogue scale （VAS） score, occurrence of nausea and vomiting between the two groups. Results The experimental group had better MAP, SpO2 and HR at T2, T3, T4 than the control group, and the difference was statistically significant （P〈0.05）. The experimental group had lower respiratory inhibition rate as 16.67% than 73.33% in the control group, and the difference was statistically significant （P〈0.05）. The experimental group had shorter awake time than the control group, and the difference was statistically significant （P〈0.05）. Both groups had no statistically significant difference in incidence of nausea and vomiting （P〉0.05）. Conclusion When obese patients undergoing painless induced abortion, propofol for induction = ideal body mass （kg） × 2.0 mg/kg, and propofol for maintenance = ideal body mass （kg） × 0.5 mg/kg can greatly improve the safety.
出处
《中国实用医药》
2018年第5期92-93,共2页
China Practical Medicine
关键词
丙泊酚
实际体质量
理想体质量
呼吸抑制
改良清醒镇静评分
肥胖患者
Propofol
Actual body mass
Ideal body mass
Respiratory depression
Improved sobersedation score
Obese patients
