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Zhang Jingwen, 1 Kong Lingling, 2 Juan11 Department of Anesthesiology, West China Thib Ob Tsev Kho Mob, Sichuan University, Lub Chaw Haujlwm Tseem Ceeb rau Congenital Defects thiab Cov Kab Mob ntsig txog, Ministry of Education, Sichuan University, Chengdu, Sichuan Province, 2 Department of Obstetrics thiab Gynecology, West Tuam Tshoj thib ob Sichuan University Tsev Kho Mob, Kev yug me nyuam tsis xws luag, Lub Tsev Kho Mob Tseem Ceeb ntawm Sichuan University of Education thiab Lwm Cov Kab Mob ntawm Ministry of Education, Chengdu, Sichuan Province Tus sau sau: Ni Huang, Department of Anesthesiology, West China Second Hospital of Sichuan University, Lub Chaw Haujlwm Tseem Ceeb ntawm Congenital Defects thiab Cov Kab Mob Niam Txiv thiab Menyuam Yaus ntawm Ministry of Education ntawm Sichuan University, South San Renmin Road, Chengdu, Sichuan Province Duan 20, 610041 Tuam Tshoj, Tel +86 18180609890, Fax +86 28855503752, Email [email tiv thaiv] Lub Hom Phiaj: Txoj kev tshawb no tau tsim txhawm rau ntsuam xyuas qhov txiaj ntsig zoo npaum li cas (ED50) thiab 95% cov koob tshuaj zoo ntawm cov tshuaj lidocaine hauv cov koob tshuaj sib txawv (ED95), cov nyhuv ntawm induction koob tshuaj propofol, thiab txiav txim siab cov koob tshuaj zoo.Pab pawg: saline (L0), lidocaine 0.5 mg / kg (L0.5), lidocaine 1.0 mg / kg (L1.0) thiab lidocaine 1.5 mg / kg (L1.5).Induce anesthesia nrog 1.0 µg / kg fentanyl.Npaj lidocaine los yog saline yog muab tom qab raws li qhia, ua raws li propofol.Cov koob tshuaj propofol rau txhua tus neeg mob tau txiav txim siab los ntawm kev siv cov qauv kev kawm saum toj saud.Cov ntsiab lus tseem ceeb yog ED50 thiab ED95 ntawm propofol induction koob. Tag nrho cov koob tshuaj propofol, lub sijhawm sawv, thiab cov xwm txheej tsis zoo tau raug kaw. Cov txiaj ntsig: ED50 (95% kev ntseeg siab lub sijhawm) ntawm propofol tau qis dua hauv pawg L1.0 thiab L1.5 dua li pawg L0 (1.6 [1.5– 1.7] mg/ kg thiab 1.8 [1.6–1.9] mg/kg, piv rau 2.4 [2.3– 2.5] mg/kg, raws li p1.0 thiab L1.5 (p> 0.05). .5 dua L0 (2.8 [2.6– 3.0] mg/kg vs 2.4 [2.3– 2.5] mg/kg; p1.0 thiab L1.5 qis dua cov hauv pawg L0 thiab L0.5 (p0.5 ntau dua uas nyob rau hauv pab pawg L0 (p0.5 yog ntau dua li cov pab pawg L0 thiab L1.0 (pConclusion: Hauv cov neeg mob uas tau txais thawj peb lub hlis twg ntawm lub tsev menyuam aspiration, intravenous lidocaine 1.0 mg / kg ua ntej txhaj tshuaj propofol txo qis ED50 ntawm propofol induction koob tshuaj. tsis muaj kev phiv loj heev, sib npaug ntawm cov nyhuv ntawm 1.5 mg / kg koob peb pom zoo 1.0 mg / kg raws li qhov kev pom zoo. Tag nrho cov koob tshuaj propofol, lub sijhawm sawv, thiab cov xwm txheej tsis zoo raug kaw.Cov txiaj ntsig: ED50 (95% kev ntseeg siab ib ntus) ntawm propofol tau qis dua hauv pawg L1.0 thiab L1.5 dua li pawg L0 (1.6 [1.5–1.7] mg / kg thiab 1.8 [1.6–1.9] mg / kg, piv rau 2.4 [2.3–2.5] mg/kg, feem, p1.0 thiab L1.5 (p> 0.05). .0 thiab L1.5 qis dua cov hauv pab pawg L0 thiab L0.5 (p0.5 ntau dua li hauv pawg L0 (p0.5 siab dua li hauv pawg L0 thiab L1.0 (pConclusion: Hauv cov neeg mob uas tau txais kev kho mob). thawj peb lub hlis twg ntawm lub tsev menyuam aspiration, intravenous lidocaine 1.0 mg / kg ua ntej txhaj tshuaj propofol txo qis ED50 ntawm propofol induction koob tsis muaj kev phiv loj, sib npaug rau cov nyhuv ntawm 1.5 mg / kg koob.Tag nrho cov koob tshuaj propofol, lub sijhawm sawv, thiab cov xwm txheej tsis zoo raug kaw.Cov txiaj ntsig: ED50 (95% kev ntseeg siab ib ntus) ntawm propofol tau qis dua hauv pawg L1.0 thiab L1.5 ntau dua li pawg L0 (1.6 [1.5–1, 7] mg / ml).кг и 1,8 [1,6–1,9] мг/кг по сравнению с 2,4 [2,3–2,5] мг/kg сответственно, p1,0 и L1,5 (p> 0,05) ), однако, как ни удивительно, ED50 была значительно выше в группе L0. kg thiab 1.8 [1.6–1.9] mg/kg piv rau 2.4 [2.3–2.5] mg/kg, ntsig txog, p1.0 thiab L1.5 (p> 0.05), txawm li cas los xij, xav tsis thoob, ED50 tau siab dua hauv pawg L0. .0.5 tshaj L0 (2.8 [2.6–3.0] mg/kg vs. 2.4 [2.3–2.5] mg/kg; p1.0 thiab L1.5 qis dua hauv pawg L0 thiab L0.5 (p0.5 ntau dua hauv pawg L0 thiab L0.5) uas nyob rau hauv pab pawg L0 (p0.5 yog ntau dua hauv pawg L0 thiab L1.0 (pConclusion: hauv cov neeg mob uas tau txais lub tsev menyuam aspiration hauv thawj peb lub hlis twg, kev siv tshuaj intravenously ntawm lidocaine ntawm koob tshuaj 1.0 mg / kg ua ntej). Kev txhaj tshuaj ntawm propofol txo qis ED50 ntawm induction koob tshuaj propofol)) tsis muaj kev phiv loj heev, sib npaug ntawm cov tshuaj ntawm 1.5 mg / kg Peb pom zoo 1.0 mg / kg raws li cov lus tseem ceeb: lidocaine, propofol , uterine aspiration, txhais tau tias siv tau zooTag nrho cov koob tshuaj propofol, lub sijhawm kom sawv, thiab cov xwm txheej tsis zoo raug kaw.L1.0 和L1.5 组异丙酚的ED50 (95% 置信区间) 显着低于L0 组 (1.6 [1.5–1.7] mg/kg 帆6别 1.8 kg 2.4 [2.3–2.5] mg/kg；p1.0 和L1.5 (p> 0.05). mg/kg vs 2.4 [2.3– 2.5] mg/kg;p1.0 和L1.5 低于L0 和L0.5 组(p0.5 大于L0 组(p0.5 大于L0 和L1.0 组p在接受妊娠早期子宫抽吸术的患者中，丙泊酚注射前静脉注射利了卡因1.0 mg/kg 1.5 mg/kg 剂量的 ED50)的效果。我们推荐1.0 mg/kg作为最佳剂量。关键词：利多卡因、丙泊酚、子宫抽吸、丈彍L1.0 和L1.5 组异丙酚的ED50 (95% L0 mg/kg vs 2.4 [2.3– 2.5] mg/kg；p1.0 和的L1.5 ： 在接受 妊圠患者 中 丙泊 酚 注射 前 静脉 注射利多卡因 注射利多卡因 注射利多卡因 徨尛了 丙泊 酚的的 ed50) 严重 副作用 相当于 相当于 1.5 mg/kg 剂量的1.0 mg / kgCov txiaj ntsig: ED50 (95% kev ntseeg siab ib ntus) ntawm propofol hauv pawg L1.0 thiab L1.5 tau qis dua hauv pawg L0 (1.6 [1.5-1.7] mg / kg thiab 1.8 [1, 6–1.9] mg /kg).кг соответственно 2,4 [2,3–2,5] мг/kg, p1,0 и L1,5 (p>0,05). m в группе L0 (2,8 [2,6–2,6–2,6]). kg, raws li, 2.4 [2.3–2.5] mg/kg, p1.0 thiab L1.5 (p> 0.05).Txawm li cas los xij, xav tsis thoob, ED50 tau nce siab dua hauv pawg L0.5 dua li hauv pawg L0 (2.8 [2.6–2.6–2.6]).3.0] mg/kg vs. 2.4 [2.3-2.5] mg/kg;p1.0 thiab L1.5 qis dua hauv pawg L0 thiab L0.5 (p0.5 ntau dua hauv pawg L0 (p0.5 siab dua L0 thiab L1. 0 pawg (p Cov Lus Qhia): Hauv cov neeg mob poj niam, Hauv cov neeg mob nyob rau hauv thawj peb lub hlis twg ntawm lub tsev menyuam aspiration, intravenous lidocaine 1.0 mg / kg ua ntej txhaj tshuaj propofol txo ED50 ntawm propofol induction koob tshuaj tsis muaj kev phiv loj, sib npaug rau 1.5 mg / kg koob Peb pom zoo 1.0 mg / kg kg raws li kev pom zoo koob tshuaj: lidocaine, propofol, uterine aspiration, txhais tau tias siv tau zoo
Vim tias propofol muaj lub neej luv luv dua li lwm cov tshuaj, propofol feem ntau yog siv los ua tshuaj loog rau hauv cov hlab ntsha los muab sedation thaum ua haujlwm sab nraud.1,2 Txawm li cas los xij, sedation nrog cov koob tshuaj ntau ntawm propofol tsuas yog cuam tshuam nrog kev ua pa thiab kev mob tshwm sim.Cov koob tshuaj ntau dua ntawm propofol ua rau muaj kev pheej hmoo ntawm apnea, sab sauv ntawm lub ntsws, thiab hypotension;3-7 thaum cov koob tshuaj qis ua rau tsis txaus sedation.Propofol ua ke nrog lwm cov tshuaj yuav txo tau txoj kev pheej hmoo ntawm kev ua pa thiab circulatory teeb meem thiab muab kev nyab xeeb thiab txaus siab sedative nyhuv.Yog li ntawd, yuav tsum muaj ib qho kev pab cuam zoo los txo cov lus teb rau kev phais thiab txo qhov xav tau ntawm propofol.Nyob rau hauv xyoo tas los no, ob qho tib si midazolam thiab dexmedetomidine tau siv rau hauv kev phais mob sab nraud, tab sis ib nrab-lub neej ntawm midazolam ntev, induction ntawm dexmedetomidine qeeb, thiab cov tshuaj yog loj, yog li siv tsawg.8.9 ib
Lidocaine yog ib qho tshuaj loog hauv zos siv dav hauv kev kho mob.10 Cov kev tshawb fawb yav dhau los tau pom tias cov tshuaj lidocaine tuaj yeem txhim kho cov nyhuv sedative ntawm propofol-raws li tshuaj loog.11-15 Lwm cov txiaj ntsig perioperative ntawm intravenous lidocaine muaj xws li alleviated propofol txhaj tshuaj, txo cov kev xav tau opioid, Ua kom rov qab ua haujlwm ntawm plab hnyuv ua haujlwm tom qab kev phais, thiab txo qis qhov tshwm sim ntawm kev mob tom qab mob ntev.16-19 Intravenous lidocaine muaj luv luv ib nrab-lub neej (90-120 min), thiab nws cov ntshav siab qhia hauv kev tshawb fawb soj ntsuam tseem qis dua cov tshuaj lom (> 5 µg. / mL).20,21 Foo et al pom zoo hauv lawv cov lus pom zoo uas tau tshaj tawm tshiab tias yog siv lidocaine hauv cov hlab ntsha, thawj koob tshuaj tsis pub ntau tshaj 1.5 mg / kg suav nrog tus neeg mob lub cev qhov hnyav yog qhov zoo.21 Kev tshawb fawb los ntawm Lili thiab al twb tau ua pov thawj tias kev tswj hwm ntawm bolus intravenous lidocaine 1.5 mg / kg ua ntej tshuaj loog induction ua rau 36% txo ED50 ntawm propofo. Лидокаин является широко используемым местным анестетиком в клинической практике.Предыдущие исследования показали, что внутривенное введение лидокаина может усиливать седативнет на предативный o hli.ускоренное восстаное жункцие жункцчного трактаиии иосиерации и снижениенижерчрчрческо боли.16-19 венный лимеенный лиотенныий иод оведения (90-120 мнция ккрови, Ntsev Lem в киниях ислалась Ниже тксическкойи (((> 5 mkg)./ml)20,21 Foo et al.в своих недавно опубликованных согласованных рекомендациях рекомендовали, чтобы при внутривенноя на ведатривенноя на а не более 1,5 мг/kg, рассчитанная с использованием идеальной массы тела пациента, была овезопласниной .уже доказали, что болюсное внутривенное введение лидокаина в дозе 1,5 мг/kg перед индукцией анините ропофорона ntawm 36%.利多卡因是临床实践中广泛使用的局部麻醉剂。 10 lub hlis dhau los丙泊酚的麻醉的镇静作用。 11-15 静脉注射利多卡因的其他围手术期益处包括减轻异丙酚注射疼痛、减少阿片类药物需求、术后胃肠功胖碠速恢倇术Lub Kaum Ib Hlis 16-19 静脉注射利多卡因半衰期短 (90-120 分钟), 临床研究报告的其血液浓度仍低于毒性浓度 (> 5 µg / mL).利多卡因，使用患者理想体重计算的初始剂量不超过 1.5 mg/kg 是安全的.21 Lili 的一项研究等人已经证明，在麻醉诱导前的静脉推注利 ntau 1.5 kg ED 50 降低 36%利多卡 临床 实践 实践 中 广泛 使用 使用 的 的 局部 局部 麻醉剂 麻醉剂麻醉剂麻醉剂 10 10 先前 可以 因 可以 增强 增强 酚 酚 酚 酚 麻醉 作用 作用 作用 作用 作用作用 作用 期益处 静脉的 静脉 手术 手术 手术 期益处 期益处 期益处注射疼痛、减少阿片类药物需求、术后胃肠功能恢复，术后慢珙玖 1 9 静脉因半衰期短 (90-120分钟），临床研究研究研究研究研究的其荀毒性浓度（(> 5 мкг /мл).20,21 foo 等在他们新发表的识 指南 中 建议，使用 鈙塨。患者体重计算的初始剂量不如果静脉，患者理想计算的不不不如果 注射利多卡因 患者 理想 计算 的 不超过 人 1.5 мг/kg 是 安全。在 麻醉诱导 前 推注利多卡因 推注利多卡因 1,5 мг /kg 可 丙泊 酚的 ed50 降低 36%l 用 于 减轻 宫腔镜 手术 患者 对 宫颈 扩张的反应。。 22 liu 等 还 证明 ， 静应。利多卡 可 显着 成人 患者 检 期间 异丙酚 诱导剂量的 ed50 ， 而 而而而而 而 患者 检 异丙酚 诱导剂量的的 ， ，不会显着影响耦嵁岡
Yog li, txoj kev tshawb no tsom mus kuaj cov txiaj ntsig ntawm cov koob tshuaj sib txawv ntawm cov tshuaj lidocaine rau ntawm ED50 thiab ED95 ntawm propofol-inducing koob tshuaj thaum lub sij hawm thawj peb lub hlis twg uterine aspiration, nrog rau kev txiav txim siab qhov koob tshuaj, uas, rau peb paub, tsis tau kawm. hauv kev tshawb fawb yav dhau los..
Tom qab ua tiav qhov tsim ntawm qhov kev sim tshuaj no, peb hla dhau qhov kev tshuaj xyuas kev coj ncaj ncees dhau los ntawm West China Second Hospital, thiab qhov txuas ntxiv no tseem yog ob peb lub hlis dhau los.Yog li ntawd, peb nrhiav kev tshuaj xyuas kev ncaj ncees los ntawm Tuam Tshoj Clinical Trials Registration Ethics Committee, ib lub koom haum ywj pheej ntawm pawg neeg saib xyuas kev ncaj ncees uas tau tsim los ntawm Tuam Tshoj Clinical Trials Registration Center.Txoj kev tshawb fawb no tau pom zoo los ntawm Pawg Neeg Saib Xyuas Kev Ncaj Ncees ntawm Tuam Tshoj Kev Tshawb Fawb Kev Tshawb Fawb Kev Tshawb Fawb (ChiECRCT20210401) thiab tau sau npe nrog Tuam Txhab Kev Tshawb Fawb Kev Tshawb Fawb (ChiCTR2100049263).Txoj kev tshawb no tau ua raws li Kev Tshaj Tawm ntawm Helsinki txij lub Cuaj Hlis 2021 txog Lub Tsib Hlis 2022, thiab peb tau txais kev tso cai sau ntawv los ntawm 100 tus neeg koom ua ntej pib txoj kev kawm.
Txoj kev tshawb fawb yav tom ntej no tau ua rau cov poj niam cov neeg mob tau teem sijhawm mus kuaj thawj lub hlis thib peb ntawm tus neeg mob sab nraud hysteroscopy raws li kev tshuaj loog hauv Sichuan University West China Second Hospital.Txoj kev tshawb no suav nrog cov neeg mob ASA lub cev muaj zog I lossis II, hnub nyoog 18-50 xyoo thiab yoo mov 6 teev (khoom) thiab 2 teev (kua) ua ntej kev phais. Cov txheej txheem cais tawm yog raws li hauv qab no: cov neeg mob uas lub cev qhov hnyav (BMI)> 28 kg / m2 lossis BMI <18 kg / m2; Cov txheej txheem cais tawm yog raws li hauv qab no: cov neeg mob uas lub cev qhov hnyav (BMI)> 28 kg / m2 lossis BMI <18 kg / m2; Критерии исключения были следующими: пациенты с индексом массы тела (ИМТ) >28 кг/м2 или ИМТ <18; Cov txheej txheem cais tawm yog raws li hauv qab no: cov neeg mob uas lub cev qhov hnyav (BMI)> 28 kg / m2 lossis BMI <18 kg / m2;Qhov hnyav: BMI> 28 kg / m2 BMI < 18 kg / m2 患者Qhov hnyav: BMI> 28 kg / m2 BMI < 18 kg / m2 患者 Критерии исключения: пациенты с индексом массы тела (ИМТ) > 28 кг/м2 или ИМТ < 18 кг/м2; Cov txheej txheem cais tawm: cov neeg mob uas lub cev qhov hnyav (BMI)> 28 kg / m2 lossis BMI < 18 kg / m2; cov neeg mob lub cev hnyav <40 kg; cov neeg mob lub cev hnyav <40 kg; пациенты с массой тела <40 кг; cov neeg mob hnyav <40 kg;体重<40公斤的患者;体重<40公斤的患者; Пациенты с массой тела < 40 кг; Cov neeg mob hnyav <40 kg;Cov neeg mob uas muaj qhov chaw mos thiab muaj keeb kwm ntawm lub ncauj tsev menyuam dilatation hauv 6 lub hlis;cov neeg mob uas tsis haum rau cov tshuaj loog hauv zos, propofol, fentanyl, lossis lwm yam tshuaj uas cuam tshuam nrog txoj kev tshawb no;Cov neeg mob uas muaj mob hnyav thiab lub raum tsis txaus, cov kab mob endocrine, cov neeg mob uas muaj cov kab mob metabolic, cov kab mob plawv, cov kab mob ntawm cov hlab ntsws los yog cov kab mob hauv nruab nrab ntawm lub paj hlwb, Kev siv cov tshuaj sedatives, analgesics, cov tshuaj uas tuaj yeem cuam tshuam cov metabolism hauv cov tshuaj loog hauv zos lossis Cov neeg mob nyob rau hauv 7 hnub Tau txais lwm yam kev sim hauv 3 lub hlis ua ntej kev tshawb fawb Cov Tshuaj lossis cov neeg mob uas koom nrog lwm yam kev sim tshuaj;cov neeg mob quav cawv los yog tshuaj lom zem;cov neeg mob uas tau qhab nia Mallampati III-IV.Txhua tus neeg koom tau raug qhia txog lub hom phiaj ntawm txoj kev tshawb fawb.
Luv luv, 100 tus neeg mob tau randomized rau hauv pawg L0, L0.5, L1.0, thiab L1.5 raws li lub computer-tsim random sib lawv liag nrog ib tug block loj ntawm 4. Cov cim naj npawb tau muab kaw rau hauv ib lub hnab ntawv opaque.Anesthesiologists uas npaj thiab tswj cov tshuaj paub pab pawg ua haujlwm.Cov kws tshawb fawb, cov neeg mob, kws phais mob, thiab cov kws saib xyuas neeg mob uas sau cov ntaub ntawv tau ua haujlwm tsis pom kev.
Tsis muaj lwm yam tshuaj tau muab tshuaj ua ntej induction ntawm tshuaj loog.Ib 22 gauge cannula tau muab tso rau hauv cov hlab ntsha thiab Ringer's lactate infusion (2 ml / kg / h) tau pib.Thaum nkag mus rau hauv chav ua haujlwm, tus neeg mob tau txais kev nqus pa oxygen los ntawm lub npog ntsej muag ntawm tus nqi ntawm 10 L / min rau 3 feeb ua ntej induction, thiab invasive ntshav siab, electrocardiogram, ua pa npaum li cas, thiab peripheral capillary oxygen saturation (SpO2) raug soj ntsuam. mus txog thaum tus neeg mob raug tso tawm.los ntawm tshuaj loog.thiab raug xa mus rau lub sijhawm postoperative mus rau lub chaw tshuaj loog.SpO2, lub plawv dhia (HR) thiab invasive ntshav siab tau sau tseg ntawm peb lub sij hawm cov ntsiab lus nram qab no: thaum lub sij hawm npaj rau induction ntawm tshuaj loog (T0), thaum kawg ntawm induction ntawm tshuaj loog (T1), thaum kawg ntawm lub ncauj tsev menyuam dilatation. (T2).Tag nrho cov kev npaj tau npaj nyob rau hauv chav tsev kub.kub, khaws cia thiab siv tam sim ntawd.Lidocaine (Sinopharm Rongsheng Pharmaceutical Co., Ltd.) 0.5 mg / kg, 1.0 mg / kg thiab 1.5 mg / kg tau diluted rau 10 ml nrog saline hauv 10 ml syringe.Kuj tseem npaj ib qho sib npaug ntawm cov kua qaub rau hauv 10 ml syringe.Kev taw qhia txog kev siv tshuaj loog tau pib nrog kev txhaj tshuaj ib zaug ntawm fentanyl 1.0 μg / kg (Yichang Renfu Pharmaceutical Co., Ltd., China).Ib feeb tom qab, npaj lidocaine los yog saline tau muab tshuaj raws li tau hais tseg rau 30 vib nas this, thiab tom qab ntawd propofol (Corden Pharma SPA, Ltalis) tau muab rau txhua tus neeg mob ntawm tus nqi ntawm 0.4 ml / s.Thawj tus neeg mob hauv txhua pab pawg tau txais propofol 2.0 mg / kg.Hauv cov neeg mob tom qab, koob tshuaj propofol tau nce lossis txo los ntawm 0.2 mg / kg, nyob ntawm cov lus teb ntawm tus neeg mob yav dhau los.Kev Hloov Kho Tus Saib Xyuas Kev Ceeb Toom/Sedation Rating Scale (MOAA/S) tau siv los ntsuas qhov tob ntawm sedation.24 MOAA/S scale yog 6-point scale thiab tau piav raws li 5: ib qho yooj yim-rau-hais lub npe nyob rau hauv ib txwm lub suab;4: pw tsaug zog tshwm sim rau lub npe hais nyob rau hauv lub suab nrov;3: tsuas yog nrog lub suab nrov thiab / lossis rov hais dua tom qab hu lub npe;2: teb tsuas yog me ntsis stimulation los yog co;1: teb tsuas yog mob contraction ntawm cov leeg trapezius;0: tsis muaj lus teb rau cov leeg trapezius. Tom qab qhov qhab nia MOAA/S yog <1, tus kws phais tau tso cai pib tso qhov chaw mos ntawm qhov chaw mos, uas qhia txog kev pib ua haujlwm. Tom qab qhov qhab nia MOAA/S yog <1, tus kws phais tau tso cai pib tso qhov chaw mos ntawm qhov chaw mos, uas qhia txog kev pib ua haujlwm. После того, как оценка MOAA/S была <1, хирургу было разрешено начать установку вагинального зеровапла, чироовапла, чироовапла ib ak. Thaum tus qhab nia MOAA/S yog <1, tus kws phais raug tso cai los pib qhov chaw mos qhov chaw mos, qhia txog kev pib ua haujlwm.在MOAA/S 评分<1 后，外科医生被允许开始放置阴道窥器，这标志着手术的开始。hauv MOAA/S После того, как оценка MOAA/S <1, хирургу было разрешено начать установку вагинального зеркалоова, что озрешено начать Thaum tus qhab nia MOAA/S yog <1, tus kws phais raug tso cai los pib tso qhov chaw mos ntawm qhov chaw mos, cim qhov pib ntawm txoj kev.Txhua qhov kev ua haujlwm yog ua los ntawm tib tus kws phais.Qhov tshwm sim tau suav tias yog qhov tsis raug yog tias MOAA / S yog ≥1 tom qab thawj koob tshuaj propofol lossis yog tias cov ceg taw tau pom txij thaum pib mus rau lub ncauj tsev menyuam;txwv tsis pub, qhov tshwm sim tau suav tias yog qhov tseem ceeb.Hauv cov xwm txheej tsis zoo, koob tshuaj propofol tau nce 0.2 mg / kg hauv cov neeg mob tom qab.Propofol raug txo los ntawm 0.2 mg / kg hauv cov neeg mob tom qab rau cov xwm txheej zoo.Yog hais tias MOAA/S yog ≥1 los yog cov ceg taw tau pom thaum lub sij hawm phais, propofol 0.5-1.0 mg / kg yog muab raws li kev kho mob xav tau.Tom qab induction ntawm tshuaj loog, yog hais tias lub sij hawm apnea ntau tshaj 1 min, nws txhais tau hais tias ua pa nyuaj siab thiab txhua yam ua pa cua tau ua kom txog rau thaum lub spontaneous respiration.Yog tias pom muaj kev cuam tshuam ntawm txoj hlab pa sab saud, tsa lub puab tsaig qis kom tso pa tawm. Yog hais tias SpO2 <92%, hypoxia tau raug txiav txim siab thiab cov txheej txheem raug tso tseg, thiab siv lub ntsej muag lub ntsej muag lub qhov cua kom normalize oxygen saturation. Yog hais tias SpO2 <92%, hypoxia tau raug txiav txim siab thiab cov txheej txheem raug tso tseg, thiab siv lub ntsej muag lub ntsej muag lub qhov cua kom normalize oxygen saturation. При SpO2 <92% определяли гипоксию и процедуру прекращали, а для нормализации сатурации кислорольдом ицевую масочную вентиляцию легких. Ntawm SpO2 <92%, hypoxia tau txiav txim siab thiab cov txheej txheem raug tso tseg, thiab siv lub ntsej muag lub ntsej muag lub qhov cua kom normalize oxygen saturation.SpO2 <92%, 则定义为缺氧并停止手术，并应用辅助面罩通气以使氧饱咸度。SpO2 <92%, 则定义为缺氧并停止手术，并应用辅助面罩通气以使氧饱咸度。 Если SpO2 < 92%, определите гипоксию и прекратите операцию, thiab также примените искусственнух векниля векниля для нормализации насыщения кислородом. Yog tias SpO2 <92%, txiav txim siab hypoxia thiab txiav tawm kev phais, thiab ua pa nrog lub npog ntsej muag kom normalize oxygen saturation. Yog tias HR yog <50 beats/min, atropine 0.5 mg tau muab. Yog tias HR yog <50 beats/min, atropine 0.5 mg tau muab. Если ЧСС <50 уд/мин, вводили атропин 0,5 мг. Yog tias lub plawv dhia <50 bpm, atropine 0.5 mg tau muab.如果HR <50 次/分钟, 则给予阿托品 0.5 mg.如果HR <50次/分钟, 则给予阿托品0.5 mg. Если ЧСС <50 уд/мин, введите 0,5 мг атропина. Yog tias lub plawv dhia <50 bpm, muab 0.5 mg atropine. Hypotension tau txhais tias yog SBP, diastolic ntshav siab (DBP), los yog txhais tau tias arterial siab (MAP) txo los ntawm ntau tshaj 20% ntawm lub hauv paus, los yog SBP <80 mmHg. Hypotension tau txhais tias yog SBP, diastolic ntshav siab (DBP), los yog txhais tau tias arterial siab (MAP) txo los ntawm ntau tshaj 20% ntawm lub hauv paus, los yog SBP <80 mmHg. Гипотензия определялась как снижение САД, диастолического артериального давления (ДАД) или грниоа дне САД) более чем на 20% от исходного уровня или САД <80 мм рт.ст. Hypotension tau txhais tias yog qhov txo qis hauv SBP, diastolic ntshav siab (DBP), lossis txhais tau tias cov ntshav siab (MAP) los ntawm ntau dua 20% ntawm cov hauv paus, lossis SBP <80 mmHg.低血压定义为SBP、舒张压(DBP) 或平均动脉压(MAP) 下降超过基线的20%, 或SBP <80 mmHg. 20%, SBP <80 mmHg. Гипотензию определяли как снижение более чем на 20% от исходного уровня САД, диастолического артериго артериал среднего артериального давления (САД) или САД <80 мм рт.ст. Hypotension tau txhais tias yog qhov txo qis tshaj 20% los ntawm qhov pib hauv SBP, diastolic ntshav siab (DBP), lossis txhais tau tias lub siab siab (MAP), lossis SBP <80 mmHg.Yog tias hypotension tshwm sim, 0.2–0.4 mg ntawm metahydroxylamine lossis 5–10 mg ntawm ephedrine raug tswj hwm, nyob ntawm qhov xwm txheej.Tag nrho cov koob tshuaj propofol, lub sijhawm ua haujlwm, thiab lub sijhawm rov qab los thaum kawg ntawm kev ua haujlwm tau sau tseg.Myoclonus thiab cov kev mob tshwm sim ntawm cov tshuaj loog hauv zos kuj tau tshaj tawm, xws li tinnitus, perioral loog, thiab palpitations tom qab propofol.
Cov ntsiab lus tseem ceeb yog ED50 thiab ED95 ntawm propofol induction koob.Cov ntsiab lus thib ob yog tag nrho cov koob tshuaj propofol, lub sijhawm rov qab ua haujlwm tom qab, kev nyuaj siab ua pa, ua pa sab sauv, hypoxia, bradycardia, hypotension, thiab postpropofol myoclonus.
Kev ywj pheej thiab tsis paub txog kev faib tawm ntawm cov ntaub ntawv kawm nyob rau hauv ib qho kev sib sau ua ke ua rau nws nyuaj rau kev tsim cov kev cai nruj nruj rau kev suav cov qauv loj.25 Tus qauv loj yog txiav txim los ntawm txoj cai nres.Cov neeg mob yuav tsum tau cuv npe ua ntej yam tsawg kawg yog rau khub ntawm cov txiaj ntsig tsis raug raug hloov mus rau cov txiaj ntsig siv tau.Kev tshawb fawb simulation tau pom tias, feem ntau, suav nrog tsawg kawg 20-40 tus neeg mob tuaj yeem muab qhov kwv yees ruaj khov ntawm lub hom phiaj koob tshuaj.Lwm qhov kev sim tshuaj loog siv txoj hauv kev no feem ntau koom nrog 20-40 tus neeg mob.26,27 Hauv peb txoj kev tshawb fawb, txhua pab pawg suav nrog 25 tus neeg mob, uas txaus rau kev txheeb xyuas kev txheeb xyuas.
SPSS 26.0 (IBM Inc., Armonk, NY, USA) tau siv los txheeb xyuas cov txiaj ntsig.Kev sim Shapiro-Wilk tau siv los txiav txim qhov kev faib tawm ntawm cov ntaub ntawv.Nruam ib txwm faib cov hloov pauv tau qhia raws li qhov txhais tau tias ± tus qauv sib txawv thiab sib piv ntawm cov pab pawg siv ib txoj kev ANOVA.Cov ntaub ntawv tsis yog ib txwm faib tau nthuav tawm raws li qhov nruab nrab (interquartile ntau yam) thiab muab piv siv Wilcoxon qib sum test.Categorical cov ntaub ntawv tau nthuav tawm ua n (%) thiab tshuaj xyuas siv qhov ntsuas chi-square.ED50 (95% CI) rau propofol yog xam raws li qhov nruab nrab ntawm qhov nruab nrab ntawm xoom tseem ceeb crossover siv ib txoj kev ANOVA nrog Bonferroni txoj kev sib piv ntawm pab pawg.ED95 (95% CI) tau kwv yees siv qhov kev pheej hmoo rov qab los. Rau txhua qhov kev ntsuam xyuas, p<0.05 tau txiav txim siab los qhia txog qhov sib txawv tseem ceeb. Rau txhua qhov kev ntsuam xyuas, p<0.05 tau txiav txim siab los qhia txog qhov sib txawv tseem ceeb. Для всех анализов считалось, что p<0,05 указывает на статистически значимые различия. Rau txhua qhov kev ntsuam xyuas, p<0.05 tau txiav txim siab los qhia txog qhov sib txawv tseem ceeb.对于所有分析，p<0.05 被认为表明有统计学意义的差异. p<0.05 被认为表明有统计学意义的差异. Для всех анализов считалось, что p<0,05 указывает на статистически значимое различие. Rau txhua qhov kev ntsuam xyuas, p<0.05 tau txiav txim siab los qhia txog qhov sib txawv tseem ceeb.
Tag nrho ntawm 121 tus neeg mob tau sau npe thiab tshuaj xyuas.Ntawm cov no, 100 tus neeg mob tau muab faib ua 4 pawg thiab suav nrog hauv kev tshuaj ntsuam zaum kawg (Daim duab 1).Cov yam ntxwv tseem ceeb ntawm plaub pawg neeg mob, suav nrog hnub nyoog, BMI, lub plawv dhia (T0), SBP (T0), DBP (T0) thiab SBP (T0), tsis txawv ntau (Table 1).
Ib theem saum toj-down uas qhia txog koob tshuaj thiab tus neeg mob teb yog qhia hauv qab no (Daim duab 2).Qhov nruab nrab propofol infusion koob tshuaj hauv L0, L0.5, L1.0, thiab L1.5 pawg yog 2.3 ± 0.2, 2.7 ± 0.3, 1.6 ± 0.2, thiab 1.7 ± 0.2 mg / kg, raws.Ntawm daim duab.3 qhia txog kev soj ntsuam ntawm cov lus teb ntawm cov tshuaj lidocaine thiab propofol hauv plaub pawg neeg mob.Table 2 qhia txog ED50 thiab ED95 (95% CI) ntawm propofol rau plaub caj npab, raws li Dixon-Massey ordinal up-down order thiab probability regression, ntsig txog. ED50 ntawm propofol hauv pawg L1.0 thiab L1.5 tau tsawg dua li hauv pawg L0 (1.6 [1.5–1.7] mg / kg; 1.8 [1.6–1.9] mg / kg vs 2.4 [2.3–2.5] mg / kg, p <0.001). ED50 ntawm propofol hauv pawg L1.0 thiab L1.5 tau tsawg dua li hauv pawg L0 (1.6 [1.5–1.7] mg / kg; 1.8 [1.6–1.9] mg / kg vs 2.4 [2.3–2.5] mg / kg, p <0.001).ED50 ntawm propofol hauv pawg L1.0 thiab L1.5 tau qis dua hauv pawg L0 (1.6 [1.5–1.7] mg / kg; 1.8 [1.6–1.9] mg / kg).kg versus 2.4 [2.3–2.5] mg/kg).0,001 r. kg, p <0.001). L1.0 和L1.5 组异丙酚的ED50 显着低于L0 组 (1.6 [1.5–1.7] mg/kg；1.8 [1.6–1.9] mg/kg vs 2.4 [2.3–2.5] mg/kg p <0.001). L0, p <0.001).propofol ED50 tau qis dua hauv pawg L1.0 thiab L1.5 ntau dua li ntawm pawg L0 (1.6 [1.5–1.7] mg / kg; 1.8 [1.6–1.9] mg / kg).kg versus 2.4 [2.3–2.5] mg/kg)./kg, p <0,001). /kg, p <0.001). Tus nqi ntawm ED50 yog siab dua hauv pab pawg L0.5 dua li hauv pawg L0 (2.8 [2.6–3.0] mg/kg vs 2.4 [2.3–2.5] mg/kg, p<0.05). Tus nqi ntawm ED50 yog siab dua hauv pab pawg L0.5 dua li hauv pawg L0 (2.8 [2.6–3.0] mg/kg vs 2.4 [2.3–2.5] mg/kg, p<0.05). Величина ED50 была выше в группе L0,5, чем в группе L0 (2,8 [2,6–3,0] мг/kg против 2,4 [2,3–2,5] мг/kg, p. ,05). ED50 yog siab dua hauv pawg L0.5 dua li pawg L0 (2.8 [2.6–3.0] mg/kg vs. 2.4 [2.3–2.5] mg/kg, p<0 .05). L0.5 组的ED50 值高于L0 组 (2.8 [2.6-3.0] mg/kg vs 2.4 [2.3-2.5] mg/kg, p<0.05). L0.5 组的ED50 值高于L0 组 (2.8 [2.6-3.0] mg/kg vs 2.4 [2.3-2.5] mg/kg, p<0.05). Группа L0,5 имела более высокие значения ED50, чем группа L0 (2,8 [2,6–3,0] мг/kg против 2,4 [2,3-2/0,5] 05). L0.5 pawg muaj ED50 qhov tseem ceeb dua li pawg L0 (2.8 [2.6–3.0] mg/kg vs. 2.4 [2.3–2.5] mg/kg, p<0, 05). Tsis muaj qhov sib txawv tseem ceeb hauv ED50 ntawm propofol ntawm pawg L1.0 thiab L1.5 (p> 0.05). Tsis muaj qhov sib txawv tseem ceeb hauv ED50 ntawm propofol ntawm pawg L1.0 thiab L1.5 (p> 0.05). Не было существенной разницы hauv ED50 пропофола между группами L1.0 thiab L1.5 (p> 0,05). Tsis muaj qhov sib txawv tseem ceeb hauv propofol ED50 ntawm pawg L1.0 thiab L1.5 (p> 0.05). L1.0组和L1.5组异丙酚的ED50差异无统计学意义 (p> 0.05). L1.0组和L1.5组异丙酚的ED50差异无统计学意义 (p> 0.05). Не было существенной разницы в ED50 пропофола между группой L1.0 thiab группой L1.5 (p> 0,05). Tsis muaj qhov sib txawv tseem ceeb hauv propofol ED50 ntawm pawg L1.0 thiab pawg L1.5 (p> 0.05).
Table 2 ED50 thiab ED95 (95% CI) ntawm plaub pawg propofol raws li kev txiav txim siab ntawm Dixon-Massey faib thiab Probit regression
Daim duab 2 Dixon nyob rau sab saum toj thiab hauv qab ntawm plaub pawg.“●” txhais tau tias siv tau, “○” txhais tau tias siv tsis tau.
Tsis muaj qhov sib txawv tseem ceeb ntawm cov pab pawg hauv lub sijhawm phais thiab lub sij hawm sawv los raws li teev nyob rau hauv Table 3 (p> 0.05). Tsis muaj qhov sib txawv tseem ceeb ntawm cov pab pawg hauv lub sijhawm phais thiab lub sij hawm sawv los raws li teev nyob rau hauv Table 3 (p> 0.05). Не было никаких существенных различий между группами в продолжительности операции и времени бемени буппами, 3 (p>0,05). Tsis muaj qhov sib txawv tseem ceeb ntawm cov pab pawg nyob rau lub sijhawm ua haujlwm thiab lub sijhawm sawv, raws li tau hais hauv cov lus 3 (p> 0.05).各组手术时间和苏醒时间差异无统计学意义 (p> 0.05), 见表3. p>0.05), 3. Не было существенной разницы во времени работы и времени пробуждения между группами (p> 0,05), канк пока з 3 Tsis muaj qhov sib txawv tseem ceeb hauv lub sijhawm ua haujlwm thiab lub sijhawm sawv ntawm pab pawg (p> 0.05), raws li qhia hauv Table 3. Qhov nruab nrab koob tshuaj ntawm tag nrho cov propofol xav tau rau tag nrho cov kev phais tau ntau dua hauv pawg L0 thiab L0.5 dua li ob pawg (p <0.05, Table 3). Qhov nruab nrab koob tshuaj ntawm tag nrho cov propofol xav tau rau tag nrho cov kev phais tau ntau dua hauv pawg L0 thiab L0.5 dua li ob pawg (p <0.05, Table 3). Средние дозы общего пропофола, необходимые для всей операции, были значитель но выше в групппах , L0 и уппах (p<0,05, thiv 3). Qhov nruab nrab koob tshuaj ntawm tag nrho cov propofol xav tau rau tag nrho cov kev ua haujlwm tau nce siab hauv pawg L0 thiab L0.5 ntau dua li ntawm ob pawg (p <0.05, Table 3).整个手术所需的总丙泊酚平均剂量在L0 和L0.5 组显着高于其他两组（p<0.05，表3）.整个手术所需的总丙泊酚平均剂量在L0 thiab L0.5 Средняя доза общего пропофола, необходимая для всей процедуры, была значительно дм в хруподимая для всей процедуры, была значительно дм в хруприч вех 5 L0 группах (p<0,05, таблица 3). Qhov nruab nrab koob tshuaj ntawm tag nrho cov propofol xav tau rau tag nrho cov txheej txheem yog qhov siab dua hauv L0 thiab L0.5 pawg dua li ntawm ob pawg (p <0.05, Table 3). Tsis muaj qhov sib txawv tseem ceeb ntawm cov pab pawg hauv qhov tshwm sim ntawm cov hlab ntsws sab sauv (p> 0.05). Tsis muaj qhov sib txawv tseem ceeb ntawm cov pab pawg hauv qhov tshwm sim ntawm cov hlab ntsws sab sauv (p> 0.05). Существенных различий между группами по частоте возникновения обструкции верхних дыхательных пубей,0ней). Tsis muaj qhov sib txawv tseem ceeb ntawm cov pab pawg hauv qhov xwm txheej ntawm cov hlab cua sab saud (p> 0.05).上气道阻塞发生率组间差异无统计学意义 (p> 0.05).上气道阻塞发生率组间差异无统计学意义 (p> 0.05). Достоверной разницы в частоте обструкции верхних дыхательных путей между группами не было (p> 0,05). Tsis muaj qhov sib txawv tseem ceeb hauv qhov xwm txheej ntawm txoj hlab ntsws sab sauv ntawm cov pab pawg (p> 0.05). Qhov tshwm sim ntawm kev nyuaj siab ua pa hauv pab pawg L0.5 yog ntau dua li hauv pawg L0 thiab L1.0 (p <0.05). Qhov tshwm sim ntawm kev nyuaj siab ua pa hauv pab pawg L0.5 yog ntau dua li hauv pawg L0 thiab L1.0 (p <0.05). Частота угнетения дыхания в группе L0,5 была выше, чем в группах L0 thiab L1,0 (p<0,05). Qhov zaus ntawm kev nyuaj siab ua pa hauv pawg L0.5 yog siab dua hauv pawg L0 thiab L1.0 (p <0.05). L0.5组呼吸抑制发生率高于L0、L1.0组（p<0.05）. L0.5组呼吸抑制发生率高于L0、L1.0组（p<0.05）. Частота угнетения дыхания в группе L0,5 была выше, чем в группах L0 thiab L1,0 (p<0,05). Qhov zaus ntawm kev nyuaj siab ua pa hauv pawg L0.5 yog siab dua hauv pawg L0 thiab L1.0 (p <0.05). Tsis muaj qhov sib txawv tseem ceeb ntawm cov pab pawg hauv qhov tshwm sim ntawm hypotension (p> 0.05), tab sis SBP poob qis tom qab tshuaj loog induction hauv pawg L0.5 ntau dua li hauv pawg L0 (p<0.01). Tsis muaj qhov sib txawv tseem ceeb ntawm cov pab pawg hauv qhov tshwm sim ntawm hypotension (p> 0.05), tab sis SBP poob qis tom qab tshuaj loog induction hauv pawg L0.5 ntau dua li hauv pawg L0 (p<0.01). Достоверных различий между группами по частоте гипотензии не было (p>0,05), но снижение САД послиц и но снижение САД послиц ин 0.5 было больше, чем в группе L0 (p<0,01). Tsis muaj qhov sib txawv tseem ceeb ntawm cov pab pawg hauv qhov tshwm sim ntawm hypotension (p> 0.05), tab sis qhov txo qis hauv SBP tom qab txhaj tshuaj loog yog ntau dua hauv pawg L0.5 dua li pawg L0 (p <0.01).低血压发生率组间差异无统计学意义（p>0.05），L0.5组麻醉诱导后SBP下降幅0L0.低血压发生率组间差异无统计学意义 (p>0.05), L0.5组麻醉诱寄后SBP下降幅0L0 Не было существенной разницы в частоте гипотензии между двумя группами (p>0,05), но снижение САД уппе L0,5 было больше, чем в группе L0 (p<0,01). Tsis muaj qhov sib txawv tseem ceeb ntawm qhov tshwm sim ntawm hypotension ntawm ob pawg (p> 0.05), tab sis qhov txo qis hauv SBP tom qab induction ntawm tshuaj loog yog ntau dua hauv pawg L0.5 ntau dua li ntawm pawg L0 (p <0.01).Tsis muaj leej twg ntawm cov neeg mob tsim bradycardia thiab hypoxia.Tsis muaj tus neeg mob qhia xeev siab, tinnitus, perioral loog, thiab palpitations.Tus neeg mob #20 hauv pab pawg L1.0 tau tsim lub ntsej muag myoclonus tom qab thawj koob tshuaj propofol 1.8 mg / kg, thiab tus neeg mob #10 hauv pawg L1.5 tau tsim myoclonus ntawm lub ntsej muag thiab sab sab tom qab thawj koob tshuaj propofol 1.4 mg / kg..Myoclonus nres tom qab 30-60 vib nas this. Tsis muaj qhov sib txawv tseem ceeb ntawm cov pab pawg hauv qhov tshwm sim ntawm myoclonus (p> 0.05). Tsis muaj qhov sib txawv tseem ceeb ntawm cov pab pawg hauv qhov tshwm sim ntawm myoclonus (p> 0.05). Достоверных различий между группами по частоте миоклонуса не было (p>0,05). Tsis muaj qhov sib txawv tseem ceeb ntawm cov pab pawg hauv qhov tshwm sim ntawm myoclonus (p> 0.05).肌阵挛发生率组间差异无统计学意义 (p> 0.05).肌阵挛发生率组间差异无统计学意义 (p> 0.05). Достоверной разницы в частоте миоклонуса между группами не было (p> 0,05). Tsis muaj qhov sib txawv tseem ceeb hauv qhov zaus ntawm myoclonus ntawm cov pab pawg (p> 0.05).
Rau peb txoj kev paub, qhov no yog thawj qhov kev tshawb fawb yav tom ntej uas qhia txog cov txiaj ntsig ntawm cov koob tshuaj sib txawv ntawm cov tshuaj lidocaine rau ntawm ED50 thiab ED95 ntawm induction koob tshuaj propofol hauv cov neeg mob uas tau txais thawj peb lub hlis twg hysteroscopy.Cov txiaj ntsig tau pom tias kev tswj hwm cov tshuaj lidocaine ntawm qhov koob tshuaj ntawm 1.0 mg / kg ua ntej txhaj tshuaj propofol txo qis ED50, ED95 thiab tag nrho cov koob tshuaj propofol, uas sib npaug rau cov nyhuv ntawm koob tshuaj 1.5 mg / kg.Yog li ntawd, peb pom zoo kom txo qis koob tshuaj 1.0 mg / kg raws li qhov zoo tshaj plaws koob tshuaj rau kev kho kom zoo rau cov tshuaj loog nrog propofol.Peb xav tsis thoob thaum pom tias kev tswj hwm cov hlab ntsha ntawm 0.5 mg / kg lidocaine nce ED50 ntawm propofol, qhia txog cov nyhuv nyuaj ntawm lidocaine.
Vim nws qhov pib tshwm sim sai thiab rov zoo sai, propofol feem ntau yog siv rau sedation hauv cov txheej txheem phais sab nraud.Txawm li cas los xij, kev siv tshuaj ntau dua ntawm propofol ua rau muaj kev pheej hmoo ntawm apnea, txoj hlab ntsws sab sauv, thiab hypotension, thaum cov koob tshuaj qis ua rau tsis txaus sedation.Yog li ntawd, yuav tsum muaj ib qho kev pab cuam zoo los txo cov lus teb rau kev phais thiab txo qhov xav tau ntawm propofol.Nyob rau hauv xyoo tas los no, ntau cov kev tshawb fawb tau pom tias muaj cov nyhuv analgesic ntawm intravenous lidocaine, suav nrog txo qhov mob tom qab txhaj tshuaj propofol, txo cov kev xav tau ntawm opioid, thiab txo qhov mob tom qab mob.Hauv lawv cov lus pom zoo tshaj tawm, Foo et al.pom zoo tias thawj koob tshuaj tsis pub ntau tshaj 1.5 mg / kg suav nrog qhov hnyav lub cev zoo tshaj plaws yuav tsum muaj kev nyab xeeb rau lidocaine hauv cov hlab ntsha.Tsis ntev los no, Liu et al.thiab Yu et al.Qhia tau hais tias kev siv cov tshuaj lidocaine hauv cov hlab ntsha ua ntej induction ntawm tshuaj loog ua rau txo qis hauv ED50 ntawm propofol hauv cov neeg mob gastroscopy thiab hysteroscopy.Yog li, peb txoj kev tshawb fawb tau tsom mus kuaj cov txiaj ntsig ntawm cov koob tshuaj sib txawv ntawm cov tshuaj lidocaine ntawm cov tshuaj propofol-induced ED50 thiab ED95 thaum lub sij hawm thawj peb lub hlis twg ntawm lub tsev menyuam aspiration thiab txiav txim siab qhov koob tshuaj zoo.Peb tsis suav cov neeg mob uas muaj keeb kwm ntawm qhov chaw mos thiab cov uas muaj lub ncauj tsev menyuam dilatation hauv 6 lub hlis vim tias peb xav tias cov neeg mob uas muaj keeb kwm ntawm qhov chaw mos los yog keeb kwm ntawm ncauj tsev menyuam dilatation muaj tsawg lub ncauj tsev menyuam thaum phais dilation dua li cov neeg mob tsis muaj keeb kwm ntawm lub ncauj tsev menyuam.dilation ntawm lub ncauj tsev menyuam ntawm tus neeg mob.28 Qhov no yuav ua rau kom tau txais txiaj ntsig zoo dua.
Intravenous lidocaine muaj ib nrab-lub neej ntawm tsuas yog 5-8 feeb, pib ntawm lub vascular txaj thiab nkag mus rau hauv peripheral cov ntaub so ntswg, ua ntej los ntawm cov cheeb tsam ntawm siab perfusion (lub plawv, ntsws, siab, po), thiab ces mus rau hauv cov cheeb tsam ntawm hypoperfusion.nqaij thiab nqaij adipose).10 Hauv peb txoj kev tshawb fawb, peb tau tswj hwm lidocaine ua ntej propofol induction kom tswj nws cov ntshav plasma nyob rau hauv qhov muaj txiaj ntsig zoo.Raws li qhov tshwm sim, kev siv 1.5 mg / kg lidocaine ua ntej propofol ua rau txo qis 26% hauv ED50 ntawm propofol, thiab 1.0 mg / kg lidocaine ua rau txo qis 30%.Cov txiaj ntsig no zoo ib yam nrog cov Liu thiab Xu, qhia tias lidocaine ntawm cov koob tshuaj no muaj cov nyhuv analgesic thiab antihyperalgesic.Kuj ceeb tias, txawm li cas los xij, ED50 tau nce nrog cov tshuaj lidocaine hauv cov hlab ntsha ntawm 0.5 mg / kg, qhia tias cov nyhuv ntawm 0.5 mg / kg koob tshuaj yuav raug thim rov qab thiab cov koob tshuaj lidocaine qis heev tuaj yeem cuam tshuam nrog cov kev mob tshwm sim hnyav dua cuam tshuam nrog kev ntxhov siab. kev txaus siab.Lidocaine ua rau ntau lub hom phiaj molecular koom nrog hauv kev mob hnyav thiab mob ntev, suav nrog N-methyl-D-aspartate (NMDA) thiab muscarinic cholinergic (m1, m3) receptors, uas yog 100-1000 npaug ntau dua li lwm lub hom phiaj.20,29 NMDA, m1 thiab m3 receptors nyob twj ywm rhiab ntawm lidocaine cov ntsiab lus hauv qab kev kho mob cov ntshav plasma concentrations.Lidocaine inhibits kev ua haujlwm ntawm tib neeg NMDA receptors ntawm nanomolar concentrations nrog qhov siab tshaj plaws inhibition hauv millimolar ntau yam, ua rau mob nyem.Lidocaine ua rau muscarinic cholinergic receptors nyob rau hauv lub concentration- thiab lub sij hawm-dependent yam.Claes et al.qhia tau hais tias kev tswj hwm ntawm lidocaine hauv cov koob tshuaj ntawm 10 thiab 30 mg / kg nce intraspinal acetylcholine tso tawm thiab ua rau muaj kev ua xua hauv nruab nrab los ntawm kev ua kom cov muscarinic receptors hauv cov nas, tab sis ib koob ntawm 1 mg / kg lidocaine tsis tau nce intraspinal acetylcholine tso tawm.30,31 Kev tshawb fawb kuj tau pom tias lidocaine thaiv cov m1 thiab m3 muscarinic receptors ntawm cov nanomolar concentrations tsawg heev (IC50 ntawm 18 nM rau m1 thiab 370 nM rau m3).Tsis tas li ntawd, ntev mus rau lidocaine ntawm IC50 tau ua rau muaj kev hloov pauv biphasic ntawm m1 thiab m3 receptors nrog kev cuam tshuam thawj zaug ua raws li 8 teev tom qab los ntawm kev nce ntxiv.Yog li, peb ib qho bolus ntawm cov koob tshuaj tsawg heev ntawm lidocaine 0.5 mg / kg yam tsis muaj kev cuam tshuam ntev tuaj yeem ua haujlwm tau zoo los ntawm inhibition ntawm m1 thiab m3 receptors.Inhibition ntawm m1 thiab m3 receptors tau tshaj tawm, uas yuav piav qhia txog qhov nce ntawm ED50 hauv pawg L0.5 hauv peb txoj kev tshawb fawb.Txawm li cas los xij, hauv peb txoj kev tshawb fawb, peb tsis tau ntsuas qhov plasma concentration ntawm lidocaine.Kev tshawb fawb ntxiv thiab kev txheeb xyuas yog xav tau kom paub tseeb tias qhov kev xav no.
Qhov nruab nrab koob tshuaj ntawm tag nrho cov propofol xav tau rau tag nrho cov kev ua haujlwm tau nce siab dua hauv pawg L0 thiab L0.5 dua li ntawm ob pawg.Qhov zaus ntawm kev nyuaj siab ua pa hauv pawg L0.5 yog siab dua li ntawm pawg L0 thiab L1.0.Qhov txo qis hauv SBP tom qab txhaj tshuaj loog hauv pawg L0.5 yog ntau dua li ntawm pawg L0.Tsis muaj leej twg ntawm cov neeg mob tsim hypoxia, raws li peb tau ua lub puab tsaig nqa lossis lub npog qhov ncauj kom raws sijhawm.Kev nce koob tshuaj ntawm tag nrho propofol, zaus ntawm kev nyuaj siab ua pa, thiab txo qis hauv cov ntshav siab tom qab induction ntawm cov tshuaj loog hauv pawg L0.5 kuj tau qhia tias cov koob tshuaj ntau ntawm propofol tuaj yeem ua rau muaj kev pheej hmoo ntawm kev ua pa thiab kev nyuaj siab.Tsis muaj qhov sib txawv ntawm qhov tshwm sim tsis zoo ntawm pawg L0, L1.0 thiab L1.5.Txawm li cas los xij, muab qhov kev tsim ntawm peb txoj kev tshawb fawb, qhov nruab nrab propofol-inducing koob tshuaj nyob rau hauv txhua pab pawg nyob ze rau ED50 tab sis qis dua ED95.Yog li, qhov tshwm sim ntawm cov xwm txheej tsis zoo yuav muaj ntau dua yog tias cov neeg mob hauv pawg L0 raug ntxias nrog propofol ntawm koob tshuaj ED95 (2.8 [2.6–3.2] mg / kg).Txawm li cas los xij, cov nyhuv ntawm lidocaine ua rau ED95 ntawm 2.0 (1.9–2.4) mg / kg thiab 2.1 (1.9–2.4) mg / kg hauv pawg L1.0 thiab L1.5, raws li, ntawm cov koob tshuaj tsawg.Cov kev sib tham saum toj no piav qhia txog vim li cas peb ntseeg tias cov nyhuv analgesic ntawm lidocaine intravenous ntawm cov koob tshuaj uas tsim nyog thiab nyob rau lub sijhawm yog qhov tseem ceeb hauv kev txo cov teeb meem propofol-induced anesthesia.Hauv peb txoj kev tshawb fawb, tsis muaj qhov sib txawv tseem ceeb hauv ED50, tag nrho cov koob tshuaj propofol, lub sijhawm sawv, thiab cov xwm txheej tsis zoo ntawm pawg L1.0 thiab L1.5.Yog li ntawd, peb pom zoo kom txo qis ntawm 1.0 mg / kg IV lidocaine raws li qhov pom zoo.
Muaj qee qhov kev txwv ntawm peb txoj kev kawm.Ua ntej, tsuas yog cov neeg mob ASA I lossis II tau suav nrog hauv txoj kev tshawb no, tab sis cov neeg mob ASA III lossis IV tuaj yeem ua rau muaj kev nyuaj siab ua pa thiab mob plawv thaum noj propofol.33 Tsis tas li ntawd, txhua tus neeg koom nrog hauv txoj kev tshawb no yog cov poj niam cev xeeb tub, thiab cov txiaj ntsig yuav cuam tshuam nrog kev sib txawv ntawm lub cev, qhov sib txawv ntawm cov txiv neej.Qhov thib ob, peb siv cov qhab nia MOAA/S los ua qhov qhia txog qib ntawm sedation es tsis yog lub hom phiaj ntsuas xws li kev saib xyuas BIS.34 Qhov thib peb, lidocaine tau muab coj los ua ib qho bolus thiab peb tsis ntsuas cov qib plasma ntawm lidocaine.Thaum kawg, ED95 yog txiav txim siab los ntawm ED50, yog li xav tau kev tshawb fawb ntxiv kom tau txais cov ntaub ntawv raug ntau dua.
Cov txiaj ntsig ntawm peb txoj kev tshawb fawb tam sim no tau pom tias kev tswj hwm kev txhaj tshuaj ntawm 1.0 mg / kg lidocaine ua ntej kev txhaj tshuaj propofol txo qis ED50, ED95, thiab tag nrho cov koob tshuaj propofol hauv cov neeg mob uas tau txais thawj peb lub hlis twg ambulatory hysteroscopy hauv qab tshuaj loog, sib npaug rau cov koob tshuaj zoo ntawm 1.5 mg / kg.Peb xav txog qhov koob tshuaj ntawm 1.0 mg / kg yog qhov zoo tshaj plaws koob tshuaj.Kuj ceeb tias, koob tshuaj txhaj tshuaj ntawm 0.5 mg / kg lidocaine nce ED50 ntawm propofol, qhia txog cov nyhuv nyuaj ntawm lidocaine.Cov kev tshawb fawb ntxiv ntawm cov txheej txheem hauv qab yog xav tau los lees paub peb cov txiaj ntsig.
Cov ntaub ntawv tau txais thaum kawm tuaj yeem tau txais los ntawm tus kws sau ntawv (Ni Huang).
Kuv xav ua tsaug rau Dr. Huang Han los ntawm peb lub tuam tsev thiab cov kws saib xyuas neeg mob hauv chav ua haujlwm rau lawv txoj kev txhawb nqa muaj zog.
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