不同镇静方案在无痛人工流产术中的应用及对认知的影响

陈曦希; 陈贵海; 汪欢; 姜徽; 黄金; 刘学胜; 刘训芹

doi:10.16766/j.cnki.issn.1674-4152.001855

不同镇静方案在无痛人工流产术中的应用及对认知的影响

doi: 10.16766/j.cnki.issn.1674-4152.001855

1.
安徽医科大学第一附属医院麻醉科，安徽合肥 230032
2.
安徽医科大学附属巢湖医院睡眠障碍科，安徽合肥 238000

基金项目:

国家自然科学基金项目 81671316

详细信息

通讯作者:
刘训芹，E-mail：liuxunqinay@163.com

中图分类号: R169.42 R614.24
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- 文章访问数: 194
- HTML全文浏览量: 156
- PDF下载量: 4
- 被引次数: 0
出版历程
- 收稿日期: 2020-09-23
- 网络出版日期: 2022-02-16

Application of different types of sedation methods in painless induced abortion and their influence on cognition of puerpera

1.
Department of Anaesthesiology, the First Affiliated Hospital of Anhui Medical University, Hefei, Anhui 230032, China

摘要

摘要: 目的比较丙泊酚和依托咪酯单用或合用在无痛人工流产术中的麻醉效果及对认知的影响。方法选取2019年1—4月在安徽医科大学第一附属医院妇科门诊进行无痛人工流产术的患者180例，采用随机数字法分为丙泊酚组(P组，53例)、依托咪酯组(E组，57例)和混合组(EP组，55例)。采用北京版蒙特利尔认知测评量表(MoCA)评估术后认知水平。记录术前、诱导后、术中、术毕的SBP、DBP、平均动脉压(MAP)、心率(HR)、脉搏血氧饱和度(SpO₂)以及麻醉效果、用药总量、手术时间、唤醒时间、离室时间和不良反应。结果 3组间术后MoCA总分和各认知域分比较差异均无统计学意义(均P＞0.05)。P组和EP组镇静效果较好，但E组有4例效果欠佳。组间SBP、DBP、MAP、HR比较差异无统计学意义(均P＞0.05)，各时点间比较差异有统计学意义(均P＜0.05)，组别和时间对SBP、DBP和MAP有交互效应(均P＜0.05)。不同干预和不同时点对SpO₂均有显著效应，且存在交互作用(均P＜0.05)。P组注射痛的发生率高于EP组和E组(均P＜0.017)，P组和EP组低氧血症的发生率高于E组(均P＜0.017)，E组肌阵挛和恶心呕吐的发生率高于P组和EP组(均P＜0.017)。结论依托咪酯和丙泊酚单药或合用对于行无痛人工流产术的患者短期认知水平无不同影响，合用效果最优，但依托咪酯单用安全性最好。
- 认知水平 /
- 依托咪酯 /
- 无痛人工流产术 /
- 丙泊酚
Abstract: Objective The aim of this study is to compare the effect of propofol and etomidate alone or combination in painless artificial abortion and their influence on cognition of puerperal. Methods One hundred and eighty pregnant women scheduled for painless induced abortion in the First Affiliated Hospital of Anhui Medical University from January to April 2019 were randomized assigned into P (propofol), E (etomidate) and EP (etomidate combined with propofol) groups. Before leaving the operating room, the cognitive level was assessed by Montreal cognitive assessment (MoCA). The figures of systolic blood pressure (SBP), diastolic blood pressure (DBP), mean arterial pressure (MAP), heart rate (HR), SpO₂ were recorded before anesthesia, and after anesthesia induction, during operation and at the end of operation. The injection pain, myoclonus, hypotension, bradycardia, hypoxemia, nausea and vomiting, and other adverse reactions were recorded. The total dose, operation time, recovery time and departure time were recorded. Results There were no significant differences in the total score and cognitive domain index scores of MoCA among the three groups (all P>0.05). The P and PE groups obtained relatively satisfactory anesthesia, but the anesthetic effect of 4 cases in the E group was not good. There was no significant difference in SBP, DBP, MAP and HR among groups (all P>0.05), however, there was significant difference in SpO₂ among different time points (all P < 0.05). There were interaction effects among groups and time points had interventions on SBP, DBP and MAP. Different interventions and different time points had significant effects on SpO₂, and there was interaction (all P < 0.05). The P group had more injection pain than the E and EP and groups (all P < 0.017), the P and EP groups had more frequent hypoxemia as compared with the E group (all P < 0.017), and myoclonus and nausea and vomiting were more frequent in the E group when compared with the P and EP groups. Conclusion The propofol and etomidate alone or combination had similar short-term effect on cognition, the combination of propofol and etomidate had the best anesthetic effective in painless abortion, however, etomidate alone had the best safety.
- Cognition /
- Etomidate /
- Painless inducing abortion /
- Propofol

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表 1 3组孕妇术前睡眠、焦虑状态和术后认知功能比较(x ±s，分)

组别	例数	ISI	SAS	MoCA
组别	例数	ISI	SAS	总分	视空间与执行功能	命名	注意	记忆与延迟记忆	语言	定向
P组	53	6.1±4.6	36.5±6.7	24.5±2.2	4.0±1.0	2.9±0.2	5.7±0.7	3.0±1.4	2.8±0.4	6.0±0.2
E组	57	6.8±5.5	38.0±7.2	25.0±2.0	4.1±1.0	3.0±0.2	5.9±0.3	3.2±1.3	2.9±0.4	6.0±0.1
EP组	55	5.4±4.4	37.0±7.4	24.9±1.7	4.1±1.0	2.9±0.3	5.8±0.5	3.2±1.2	2.9±0.4	6.0±0.0
F值		1.121	0.592	1.082	0.106	0.309	1.591	0.492	0.069	1.072
P值		0.328	0.554	0.341	0.900	0.734	0.207	0.612	0.933	0.345

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表 2 3组孕妇不同时间点生命体征比较(x ±s)

组别	例数	时点	SBP(mm Hg)	DBP(mm Hg)	MAP(mm Hg)	HR(次/min)	SpO₂(%)
P组	53	T0	128.7±12.8	80.4±8.6	96.6±9.0	92.3±18.2	98.9±1.0
		T1	109.5±11.9^a	65.9±7.2^a	80.4±7.6^a	86.7±11.9	94.5±6.6^a
		T2	115.9±13.3	74.4±10.6	88.2±10.7	78.1±11.7	97.5±1.5
		T3	120.4±12.5	78.9±9.9	92.8±10.3	76.2±9.3	98.2±1.2
E组	57	T0	129.0±12.3	79.5±8.4	96.0±8.9	90.4±16.6	98.8±0.9
		T1	115.7±11.2	70.8±6.7	85.8±7.0	86.0±15.3	98.4±1.4
		T2	118.9±17.1	76.1±11.1	90.3±12.0	78.9±14.4	98.0±1.2
		T3	117.4±14.0	74.0±11.7	88.5±11.7	76.3±13.2	98.2±1.1
EP组	55	T0	128.2±12.0	81.6±9.7	97.1±10.0	89.6±14.3	98.9±0.9
		T1	109.8±10.6^a	67.7±7.2^a	81.7±7.5^a	87.3±13.6	96.0±4.4^a
		T2	114.8±13.6	74.5±11.9	88.0±11.8	77.7±13.1	97.7±1.6
		T3	118.2±12.5	76.9±10.5	90.7±10.7	75.2±12.1	98.0±1.4
组间比较	F值		0.824	0.016	0.167	0.087	12.535
	P值		0.441	0.984	0.847	0.917	＜0.001
时间比较	F值		112.117	77.313	104.235	79.872	28.523
	P值		＜0.001	＜0.001	＜0.001	＜0.001	＜0.001
交互作用	F值		3.146	4.625	4.777	0.410	7.650
	P值		0.008	＜0.001	＜0.001	0.829	＜0.001
注：与E组比较，^aP＜0.05。

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表 3 3组孕妇不良反应发生率比较[例(%)]

组别	例数	注射痛	低血压	心动过缓	低氧血症	肌颤	恶心呕吐
P组	53	34(64.2)^ab	1(1.9)	0(0.0)	13(24.5)^a	0(0.0)^a	4(7.6)^a
E组	57	3(5.3)^b	1(1.8)	4(7.0)	0(0.0)	26(45.6)	17(29.8)
EP组	55	13(23.6)	1(1.8)	2(3.6)	8(14.6)^a	5(9.1)^a	5(9.1)^a
χ²值		46.829	0.435	3.661	15.121	42.535	13.030
P值		＜0.001	>0.999	0.168	0.001	< 0.001	0.001
注：与E组比较，^aP＜0.05;与EP组比较，^bP＜0.05。

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表 4 3组孕妇用药总量、手术时间、唤醒时间和离室时间比较(x ±s)

组别	例数	用药总量(mL)	手术时间(min)	唤醒时间(min)	离室时间(min)
P组	53	12.2±1.7^ab	6.4±1.3	6.3±0.8	37.5±11.1^a
E组	57	13.2±2.1	6.5±1.5	6.0±3.2	46.2±19.8
EP组	55	13.1±2.6	6.4±1.4	6.2±0.9	42.5±13.2
F值		3.781	0.126	0.228	3.756
P值		0.025	0.882	0.750	0.026
注：与E组比较，^aP＜0.05;与EP组比较，^bP＜0.05。

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