OBJECTIVE To evaluate the effect of propofol with tramadol anesthesia in induced abortion. METHODS 400 ASAⅠ～Ⅱ pregant women in 1～2 months undergoing inducde abortion received intravenous anesthesian with propofol and tramadol(group I)or without anesthesia (group Ⅱ) .Group I was administrated tramadol 1 mg/kg with propofol 1.5 mg/kg. During operation, propofol 0.1～0.3 mg/kg was administrated per-fifty seconds.BP、 HR、 SPO2 were measured at following points:before operation,during operation and after operation.Compared between both groups. RESULTS Compared with before operation, BP、 HR、 SPO2 in both groups were decreased during operation. After operation, BP、 HR、 SPO2 in both groups restored to the lever of before operation.BP、 HR、 side effects in group Ⅱ were significantly decreased as compared with that of groupⅠ (P0.01) . CONCLUSIONS Propofol with tramadol for induced abortion at anesthesia is highly effective. It reduces side effects, is a safe and effective anesthesia method for these pregant women.

目的:观察氟比洛芬酯对宫腔镜手术患者的镇痛效果。方法:120例宫腔镜手术患者随机分为两组,氟比洛芬酯组(A组)和哌替啶组(B组),每组各60例。当患者术后出现疼痛时A组缓慢静脉注射氟比洛芬酯50mg,B组肌肉注射哌替啶50mg,进行术后镇痛,记录两组镇痛起效时间,持续时间,VAS评分及不良反应。结果:A与B组镇痛起效时间分别为15.2±5.2min和16.2±4.2min,维持时间分别为8.4±2.2h和8.6±2.8h,VAS平均评分分别为2.6±0.8和2.5±0.6.镇痛效果比较两组无显著差异(P>0.05)。A组不良反应发生率3.3%,明显低于B组33.3%。结论:氟比洛芬酯用于宫腔镜手术术后镇痛效果确切,不良反应发生率低,是一种安全有效的镇痛药物。

Objective: To evaluate the efficacy of xafon and tramadol on patient-controlled intravenous analgesia (PCIA) in patients underwent larynx cancer operations. Methods: 40 patients (ASA Ⅰ-Ⅱ) larynx cancer operations under general anesthesia were randomly allocated to either group L or gruop T with 20 cases each.At the time of wound closure,xafon was administered intravenously at a dose kf 8mg(group L), tramadol was administered intravenously at a dose of 100 mg (group T). The analgesic prescription included xafon 48mg diluted with Ns to 120ml(group L),tramadol 1000mg diluted with Ns to 120ml(group T),and continuous infused at a rate of 2ml/h, bolus dose was 0.5ml and lock-out interval 15min. To observe the visual analgesia score (VAS)、Bruggrmann comfort score(BCS) and adverse events during the analgesia. Results: There was no statistical difference in VAS and BCS (P0.05). Group T was higher than group L in nausea、vomitus and diaphoresis,et al. Conclusion: Group L can provide the same analgesic efficacy as group T. Postoperative analgesia with xafon is more worthy of application in clinic associated with a lower incidence of adverse events.

目的比较术后持续输注吗啡与曲马多的术后镇痛疗效.方法80例妇科手术病人随机分为M(morphine)组与T(tramal)组.M组注入负荷量后,奥贝泵内持续输入吗啡1.5 mg、氟哌利多1.25 mg、布比卡因72 mg,加盐水稀释至48 ml,T组注入负荷量后,奥贝泵内持续输入曲马多300 mg、氟哌利多1.25 mg、布比卡因72 mg,加盐水稀释至48 ml.结果术后镇痛效果M组优于T组,排气时间T组明显少于M组,并发症较M组少.结论术后持续输入吗啡与曲马多作为术后镇痛各有利弊,临床应用时要尽可能发挥其各自优点.

目的比较硬膜外与静脉自控镇痛(PCEA、PCIA)在术后镇痛中的临床效果.方法 60例在硬膜外麻醉下行妇科手术患者,随机分为硬膜外注射吗啡病人自控镇痛(PCEA)组和静脉注射吗啡病人自控镇痛(PCIA)组.PCEA组在手术结束时,经硬膜外导管注入负荷量(吗啡1mg+0.9%生理盐水至5ml),然后连接镇痛泵在术后患者感到疼痛时自行给药镇痛,给药剂量每次吗啡0.2mg,锁定时间为20min;PCIA组在手术结束时静脉注入负荷量(吗啡0.5～1mg)然后连接镇痛泵在术后患者感到疼痛时自行给药镇痛,给药剂量每次吗啡1mg,锁定时间为5min.术后4、8、12、24h进行观察,并记录吗啡用药量、疼痛评分(VAPS)、平均动脉压、呼吸频率、镇静程度和恶心、呕吐等情况.结果术后24h用药总量PCIA组明显高于PCEA组;术后疼痛评分PCIA组在术后4、8、12h高于PCEA组;PCIA组术后镇静程度明显高于PCEA组;PCIA组恶心、呕吐发生率及程度明显高于PCEA组;患者对术后镇痛总体满意度评估PCEA组略高于PCIA组,但无统计学差异;2组患者术后各时相呼吸频率及平均动脉压都在正常范围,且无统计学差异.结论 PCEA、PCIA均达到较好的镇痛效果,减轻术后应激反应.PCIA组恶心、呕吐发生率高,且易发生明显镇静.对于硬膜外麻醉病人术后镇痛首选PCEA,对于非硬膜外麻醉的病人术后镇痛可选择PCIA.

长期以来分娩疼痛一直困扰着育龄妇女,如何减轻产痛一直是产科医生和孕妇所关心的问题.随着人们生活条件的改善,文化程度的提高,对无痛分娩的要求也愈加迫切.在医学科学迅速发展的今天,特别是20世纪70年代椎管内注药镇痛获得成功以来,麻醉医生已经能够为产妇提供较为有效也相对安全的镇痛手段.我院吸取国内外先进的经验,将布比卡因复合芬太尼用于分娩镇痛取得了比较满意的效果,现报告如下:

目的探讨罗哌卡因芬太尼复合硬膜外腔阻滞用于分娩镇痛的效果及对产力、产程、分娩方式、母婴的影响.方法选择自愿要求分娩镇痛的初产妇30例作为镇痛组,30例未要求分娩镇痛的产妇作为对照组.当镇痛组产妇产程进入活跃期并且宫口开大3cm后,选择L2～4椎间隙行硬膜外穿刺并向头端置入导管3～4cm.由硬膜外导管注入0.2%罗哌卡因和2μg/ml芬太尼混合液5ml作为试验量,观察无蛛网膜下腔阻滞和局麻药中毒征象后,再注入该混合液3～7ml建立镇痛平面.然后连接日本产奥贝微量输液泵以2ml/h速率持续硬膜外腔泵入该混合液.控制阻滞平面在T10以下,在宫口开全时停药.对照组产妇进入活跃期后不用任何镇痛药.观察分娩开始后产妇的生命体征及VAS评分.监测宫缩及胎心变化.记录产程、分娩方式、催产素用量及失血量,对新生儿进行Apgar评分,观察恶心、呕吐等不良反应.结果①镇痛组产妇用药5min后疼痛缓解,与镇痛前相比有极显著差异(P＜0.01);产妇镇痛前后生命体征无明显变化;②镇痛组第1产程比对照组明显缩短(P＜0.01),2组产妇宫缩、胎心无明显变化(P＞0.05);③2组产妇分娩方式无显著差异(P＞0.05);④2组产妇失血量、催产素用量及新生儿Apgar评分无显著差异(P＞0.05);⑤2组产妇各有1例发生恶心、呕吐,其他不良反应未见发生.结论罗哌卡因芬太尼复合硬膜外腔阻滞用于分娩镇痛效果确切,运动神经阻滞轻,对产力、产程、分娩方式及母婴一般状况无不良影响,消除了产妇及产科医生对分娩镇痛的疑虑,具有临床推广价值.