论文部分内容阅读
目的 观察鼻内滴注右美托咪定在人工流产术中的镇静镇痛效果.方法 选取2014年4月至2015年1月大连医科大学附属第二医院行人工流产患者300例,按随机数字表法分为P组、DP组和SP组,每组100例.P组患者接受0.9％氯化钠滴鼻,静脉注射0.9％氯化钠和丙泊酚;DP组患者接受右美托咪定滴鼻,静脉注射0.9％氯化钠和丙泊酚;SP组患者接受0.9％氯化钠滴鼻,静脉注射舒芬太尼和丙泊酚.比较三组间手术时间、缩宫素用量、苏醒时间、苏醒至离床时间、苏醒至出院时间、失血量、吸出组织质量、丙泊酚追加量、丙泊酚总量、宫缩痛评分、不良反应、医生满意率、患者满意率和手术条件满意率等.结果 三组手术时间、苏醒时间、苏醒至离开手术床时间、苏醒至出院时间、吸出组织质量和不良反应发生率比较差异无统计学意义(P＞0.05);DP组失血量、缩宫素用量、丙泊酚追加量和丙泊酚总量明显低于P组和SP组[(5.0±3.2) ml比(7.5±3.8)和(10.0±3.4) ml、(7.0±3.3)U比(10.0±3.1)和(12.0±2.9)U、(0.52±0.02) mg/kg比(0.81±0.04)和(0.75±0.02) mg/kg、(1.5±0.3) mg/kg比(2.8±0.4)和(2.6±0.5) mg/kg],差异有统计学意义(P＜0.05).DP组术后即刻、术后15 min和术后30 min宫缩痛评分均明显低于P组和SP组[(3.1±0.2)分比(5.1±0.9)和(3.9±0.3)分、(3.0±0.6)分比(5.0±0.7)和(3.8±0.8)分、(2.8±0.3)分比(5.0±0.5)和(3.3±0.4)分],SP组明显低于P组,差异均有统计学意义(P＜0.05).DP组医生满意率、患者满意率和手术条件满意率均明显高于P组和SP组[95.0％(95/100)比10.0％ (10/100)和60.0％ (60/100)、75.0％ (75/100)比15.0％(15/100)和65.0％ (65/100)、90.0％(90/100)比30.0％(30/100)和80.0％(80/100)],SP组高于P组,差异有统计学意义(P＜0.05).结论 在人工流产术中应用鼻内滴注右美托咪定(1 μg/kg)不仅可以产生有效的镇静抗焦虑作用,还可以减少丙泊酚用量和失血量.鼻内滴注右美托咪定联合静脉注射丙？白酚与静脉注射丙泊酚和舒芬太尼相比,患者和医生满意度评分更高,且未见明显不良反应.“,”Objective To study the sedation and analgesia effect of intranasal drip with dexmedetomidine in induced abortion.Methods Three hundred patients scheduled underwent induced abortion from April 2014 to January 2015 in the Second Affiliated Hospital of Dalian Medical University were selected.The patients were divided into P group,DP group and SP group by random digits table method with 100 cases in each group.The patients of P group received 0.9％ sodium chloride intranasal drip and 0.9％ sodium chloride and propofol intravenous injection,the patients of DP group received dexmedetomidine intranasal drip and 0.9％ sodium chloride and propofol intravenous injection,the patients of SP group received 0.9％ sodium chloride intranasal drip and sufentanil and propofol intravenous injection.The operation time,oxytocin dose,recovery time,recovery to leave the operating bed time,recovery to discharge time,blood loss,quality of aspirated tissue,propofol additional dose,propofol total dose,uterine contraction pain score,adverse reactions,satisfaction rate of doctors,satisfaction rate of patients and satisfaction rate of hand operation conditions were compared among 3 groups.Results There were no statistical differences in operation time,recovery time,recovery to leave the operating bed time,recovery to discharge time,quality of aspirated tissue and incidence of adverse reactions among 3 groups (P＞0.05).The blood loss,oxytocin dose,propofol additional dose and propofol total dose in DP group were significantly lower than those in P group and SP group:(5.0 ± 3.2) ml vs.(7.5 ± 3.8) and (10.0 ± 3.4) ml,(7.0 ± 3.3) U vs.(10.0 ± 3.1) and (12.0 ± 2.9) U,(0.52 ± 0.02) mg/kg vs.(0.81 ± 0.04) and (0.75 ± 0.02) mg/kg,(1.5 ± 0.3) mg/kg vs.(2.8 ± 0.4) and (2.6 ± 0.5) mg/kg,there were statistical differences (P＜0.05).The uterine contraction pain score immediate postoperative,postoperative 15 min and postoperative 30 min in DP group was significantly lower than that in P group and SP group:(3.1 ± 0.2) scores vs.(5.1 ± 0.9) and (3.9 ± 0.3) scores,(3.0 ± 0.6) scores vs.(5.0 ± 0.7) and (3.8 ± 0.8) scores,(2.8 ± 0.3) scores vs.(5.0 ± 0.5)and (3.3 ± 0.4) scores,the score in SP group was significantly lower than that in P group,and there were statistical differences (P＜0.05).The satisfaction rate of doctors,satisfaction rate of patients and satisfaction rate of hand operation conditions in DP group were significantly higher than those in P group and SP group:95.0％ (95/100) vs.10.0％ (10/100) and 60.0％ (60/100),75.0％ (75/100) vs.15.0％ (15/100) and 65.0％ (65/100),90.0％ (90/100) vs.30.0％ (30/100) and 80.0％ (80/100),the satisfaction rates in SP were significantly higher than those in P group,and there were statistical differences (P＜0.05).Conclusions Sedation with intranasal drip dexmedetomidine (1 μg/kg) provides effective antianxiety,reduces dose of propofol and blood loss in induced abortion.Compared with propofol or propofol combined with sulfentanil,dexmedetomidine intranasal drip combined with propofol intravenous injection has higher satisfaction scores of patients and doctors,and no obvious adverse reactions.