Application of Lornoxicam as Supplement to Propofol Anaesthesia in Painless Induced Abortion<?xml:namespace prefix = o ns = "urn:schemas-microsoft-com:office:office" />

张兴梅^*　王桂龙^#　王冬青^*　胡毅平^#

^*无锡市第二人民医院麻醉科，无锡 214002

^#无锡市第一人民医院麻醉科，无锡 214002

Xing-mei Zhang*, Gui-long Wang#, Dong-qing Wang*, Yi-ping Hu#

^*Department of Anesthesiology, Wuxi Second People's Hosptial, Wuxi 214002, China
^# Department of Anesthesiology, Wuxi First People's Hosptial, Wuxi 214002, China

ABSTRACT

Objective：To evaluate efficacy and safety of lornoxicam as supplement to propofol anaesthesia in painless abortion.
　　Methods：60 ASA I-II pregnant women undergoing painless abortion were enrolled and randomly divided into treatment group(n=30) and control group(n=30). Pregnant stage was in the first or second months. In the control group, patients were administrated intravenously propofol alone; In the treatment group, 8 mg lornoxicam was used in combination with propofol. Both groups were infused intravenously by two phases, in first phase drug was used until patients were deeply sedated, in second phase (when uterocervical dilation) 50% initial dose was boosted. Blood pressure, heart rate, SpO₂, breath frequency, revival time, propofol dosage, post-operative nausea and vomiting(PONV), vertigo and postoperative uterotonic pain (adopt VAS grade) in two groups were compared in inducing and maintaining phases.
　　Results：Propofol dosage, postoperative uterotonic pain and rate of breath inhibition in treated group were less than those in control group (P＜0.05).However, it was of no statistical significances in two groups for data of blood pressure, heart rate and SpO₂.
　　Conclusions：Lornoxicam can reduce propofol dosage and respiratory inhibition rate, strengthen analgesia effect of propofol without more side effects when used as supplement to propofol anaesthesia in painless induced abortion.
　　Key words：Lornoxicam; Propofol; Painless abortion

丙泊酚由于起效快、半衰期短现已广泛用于日间手术，但其以镇静作用为主。本研究对氯诺昔康合用丙泊酚静脉麻醉行无痛人工流产术进行评价。<?xml:namespace prefix = o ns = "urn:schemas-microsoft-com:office:office" />

一、资料与方法
　　病例选择: 选择ASAⅠ～Ⅱ级妊娠1～2个月自愿施行人工流产术的孕妇60例，术前禁食，免用术前用药。患者外阴清洗后取截石位，开放前臂静脉，鼻导管吸氧，两组术者相同。
　　麻醉方法: 将患者随机分成两组，对照组30例，单纯丙泊酚静脉麻醉；治疗组30例，静脉注射氯诺昔康(Nycomed Austria Gmbh, 批号932750)8mg后行丙泊酚静脉麻醉。两组丙泊酚(AstraZeneca S.P.A.,批号BY951)均采用2次推注法，首次给药至深镇静(45～60s内注完)，2～3min后扩宫口时再追加50%诱导量，术中根据患者有无体动反应适量追加丙泊酚至体动反应消失。
　　观察指标及疗效标准: 两组术前、术中用惠普监测仪监测BP、HR、SpO₂和RR，记录诱导时间(开始注射丙泊酚至意识消失)，苏醒时间(末次给药至呼之睁眼)，术后VAS评分^[1](10cm疼痛评分尺，0为无痛，10为难以忍受的剧痛)，术后头晕、恶心呕吐发生率，下床时间。
　　统计学分析: 所得计量资料以均数±标准差(±ｓ)表示，采用t检验；计数资料采用c²检验。

二、结  果
　　1. 两组一般资料及手术诱导情况
　　两组患者的年龄、体重，手术方法、手术时间、诱导时间及剂量经比较均无显著差异(P >0.05)见表1。对照组有11例(36.7%)治疗组有5例(16.7%)术中发生体动反应，此时追加1/4～1/2诱导量丙泊酚，对照组丙泊酚总量(181.6±18.9)mg，治疗组为(152.5±12.6)mg，两组比较有显著差异(P <0.05)。
　　2. 两组患者术中生命体征变化
　　两组生命体征变化见表2。两组诱导和手术过程中MAP和HR平稳，无1例使用升压药或阿托品。
　　3. 两组术后苏醒情况
　　所有患者麻醉期间SpO₂均在96%以上，在诱导后两组患者均有不同程度的呼吸抑制，表现为呼吸频率减慢和幅度的减弱，对照组为25例(83.3%)，治疗组为15例(50.0%)。所有呼吸抑制的患者中呼吸频率最低者为8次min^-1，经托下颌和手术刺激后即恢复正常。术后宫缩痛VAS评分治疗组(1.2±0.5)优于对照组(3.5±1.6)。
　　4. 两组苏醒情况见表3。

三、讨  论
　　丙泊酚作为一种短效的静脉全麻药已被广泛用于人工流产手术的麻醉, 但其以镇静作用为主，术后宫缩痛的发生率较高，故丙泊酚配伍芬太尼已被广泛用于人工流产手术的麻醉，但同时也增加了呼吸抑制的发生率^[2,3]。氯诺昔康属于非甾体类镇痛药，通过抑制环氧化酶(COX)活性而抑制前列腺素合成，妇科手术术前使用8mg氯诺昔康能有效地减轻术后疼痛^[4,5,6]。治疗组VAS评分明显低于对照组，氯诺昔康用于门诊人工流产手术镇痛效果确切。丙泊酚对呼吸有较明显的影响，单纯加大剂量易至麻醉安全性降低，我们认为氯诺昔康合用丙泊酚静脉麻醉下行无痛人工流产术时，具有较好的协同作用。可使丙泊酚用量减少，从而减少了呼吸抑制的发生率。氯诺昔康的不良反应主要有头晕和恶心呕吐，本实验结果显示氯诺昔康与丙泊酚伍用时没有增加头晕和恶心呕吐的发生率。

　　总之，氯诺昔康合用丙泊酚静脉麻醉行无痛人工流产手术可减少丙泊酚用量和呼吸抑制的发生，增强镇痛效果而不增加不良反应。<?xml:namespace prefix = o ns = "urn:schemas-microsoft-com:office:office" />

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