目的 评价地佐辛复合丙泊酚静脉麻醉应用于宫腔镜电切术的有效性与安全性.方法 选择90例择期宫腔镜电切术患者,随机分为地佐辛复合丙泊酚组(A组)、芬太尼复合丙泊酚组(B组)及单纯丙泊酚组(C组).麻醉诱导A组静脉滴注地佐辛0.1 mg/kg(用0.9%氯化钠溶液稀释成10 ml),后加用丙泊酚2 mg/kg;B组静脉滴注芬太尼1 μg/kg(用0.9%氯化钠溶液稀释成10 ml),后加用丙泊酚2 mg/kg;C组静脉滴注0.9%氯化钠溶液10 ml,后加用丙泊酚2 mg/kg.麻醉维持为微泵持续注入丙泊酚5 mg·kg-1·h-1,若有体动或皱眉等情况,另外单次静脉滴注丙泊酚0.5 mg/kg.记录各组术前、术中、术后收缩压、舒张压、心率、脉搏氧饱和度;记录丙泊酚总用量、麻醉起效时间(开始注药至意识丧失时间)和意识恢复时间(从停药至呼之能睁眼时间);记录术中体动、呼吸抑制及术后恶心、呕吐等不良反应的发生情况;记录患者清醒后的5、10、20及30 min的视觉模拟(VAS)评分.结果 丙泊酚总用量,C组明显多于A、B组(P＜0.05);麻醉起效时间和意识恢复时间3组间差异无统计学意义(P＞0.05);术中体动、呼吸抑制及术后恶心、呕吐等不良反应,A组明显少于B、C组(P＜0.05);A、B组清醒后的5、10及20 min VAS评分均低于C组(P＜0.05);A组清醒后的30 min VAS评分低于B、C组(P＜0.05).结论 地佐辛复合丙泊酚,可明显提高宫腔镜下电切时患者的镇痛效果,明显减少术中丙泊酚的用量,明显减轻患者的术后疼痛,且无明显的不良反应.地佐辛复合丙泊酚可安全有效地应用于宫腔镜电切术的麻醉.%Objective To evaluate the effectiveness and safety of the application of Dezocine combined with propofol as an intravenous anesthesia in hysteroscopic myometrial or polyp resection. Methods 90 patients undergoing selective hystero-scopes electrotomy operations were divided into three groups randomly: group A ( dezocine combined with propofol), group B ( fentanyl combined with propofol ) and group C ( merely propofol ). An intravenous induction of anesthesia of dezocine 0. 1 mg/ kg in 0. 9% Natrium chloride injection 10 ml and later propofol 2 mg/kg was performed in group A; Group B was given an intravenous inductin of anesthesia with Fentanyl 1 μLg/kg in 0. 9% Natrium chloride injection 10 ml and later propofol 2 mg/kg; Group C was given an intravenous injection of 0. 9% Natrium chloride injection 10 ml and later propofol 2 mg/kg. Micro pump continuous infusion of propofol 5 mg · kg ~ · h ~ was used for maintenance of anesthesia, and an single intravenous infusion of Propofol 0. 5 mg/kg was added if patients appeared body movement and a frown and so on. Systolic blood pressure ( SBP ), dias-tolic pressure ( DBP ), heart rate and pulse oxygen saturation before, in the middle and after operation of each group were recorded ; total dose of Propofol, the onset time ( from the point of infusion to the point of losing consciousness ) and recovery time ( from drug withdrawal to the point of opening eyes upon calling ) were recorded; Intra - operative body movement, respiratory depression and some postoperative adverse reaction such as nausea and vomiting were recorded; Visual simulation scores ( VAS ) of the patients 5 , 10, 20 and 30 minutes after recovering were recorded. Results Total dosages of propofol in group A or group B were less than that in group C; No differences were found in the onset time and recovery time in the three groups ( P > 0. 05 ); Adverse events ( body movement, respiratory suppression, nausea, and vomiting ) in group A was less than those in group C or group B. VAS score 5, 10 minutes after recovery in group A and group B were lower than that in group C ( P < 0. 05 ); VAS score 30 minute after recovery in group A was lower than those in group C or group B significantly ( P < 0. 05 ). Conclusion Dezocine combined with propofol can largely relieve patient's pain in hysteroscopic myometrial or polyp resection and significantly decrease the total dosage of Poropofol. With its powerful analgesia effect and little adverse reaction, Dozocine combined with Pro-posol can be effectively and safely applied to intravenous anesthesia in electrotomy with hysteroscope.
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