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Zhang Jingwen,1 Kong Lingling,2 Juan11Umnyango Wezokubulala Izinzwa, Isibhedlela Sesibili Sase-West China, Inyuvesi yase-Sichuan, Ilabhorethri Ebalulekile Yokukhubazeka Kokuzalwa Nezifo Ezihlobene, Umnyango Wezemfundo, Inyuvesi yase-Sichuan, i-Chengdu, Isifundazwe sase-Sichuan, 2 Umnyango Wezokubelethisa kanye Nezifo Zabesifazane, I-West China Yesibili Isibhedlela saseSichuan University, ukukhubazeka kokuzalwa, Ilabhorethri Ebalulekile yaseSichuan University of Education kanye Nezifo Ezihlobene Nomnyango Wezemfundo, e-Chengdu, eSifundazweni SaseSichuan Umbhali ohambelanayo: u-Ni Huang, uMnyango Wezokubulala Izinzwa, Isibhedlela Sesibili Sase-West China sase-Sichuan University, Ilabhorethri Ebalulekile Yokukhubazeka Kokuzalwa kanye Nezifo Zomama Nezingane zoMnyango Wezemfundo waseSichuan University, South San Renmin Road, Chengdu, Sichuan Province Duan 20, 610041 China, Tel +86 18180609890, Fax +86 28855503752, I-imeyili [i-imeyili ivikelwe] Injongo: Lolu cwaningo lwakhiwe ukuhlola isilinganiso esisebenzayo esimaphakathi (ED50) kanye nemithamo esebenzayo engama-95% ye-lidocaine ye-intravenous elawulwa ngemithamo ehlukene(ED95), umphumela womthamo wokungeniswa we-propofol, kanye nokunquma umthamo ofanele.Iqembu: i-saline (L0), i-lidocaine 0.5 mg/kg (L0.5), i-lidocaine 1.0 mg/kg (L1.0) kanye ne-lidocaine 1.5 mg/kg (L1.5).Dala izinzwa ngo-1.0 µg/kg fentanyl.I-lidocaine elungisiwe noma i-saline ilawulwa kamuva njengoba iqondiswa, ilandelwa yi-propofol.Umthamo we-propofol wesiguli ngasinye wanqunywa kusetshenziswa idizayini yocwaningo elandelanayo yokuya phansi.Iziphetho eziyinhloko kwakuyi-ED50 ne-ED95 yomthamo wokungeniswa kwe-propofol. Isamba semithamo ye-propofol, isikhathi sokuvuka, nezenzakalo ezimbi zarekhodwa.Imiphumela: I-ED50 (i-95% yesikhathi sokuzethemba) ye-propofol yayiphansi kakhulu kumaqembu L1.0 kanye ne-L1.5 kuneqembu L0 (1.6 [1.5– 1.7] mg/ kg kanye no-1.8 [1.6– 1.9] mg/kg, uma kuqhathaniswa no-2.4 [2.3–2.5] mg/kg, ngokulandelana; p1.0 kanye ne-L1.5 (p> 0.05) Nokho, ngokumangalisayo, i-ED50 yayiphezulu kakhulu eqenjini L0 .5 kune-L0 (2.8 [2.6– 3.0] mg/kg vs 2.4 [2.3– 2.5] mg/kg; p1.0 kanye ne-L1.5 babephansi kunalabo abaseqenjini L0 kanye ne-L0.5 (p0.5 yayinkulu kune ukuthi eqenjini L0 (p0.5 yayinkulu kunaleyo emaqenjini L0 no-L1.0 (pIsiphetho: Ezigulini ezathola isifiso se-uterine se-trimester yokuqala, i-intravenous lidocaine 1.0 mg/kg ngaphambi komjovo we-propofol yehlisa kakhulu i-ED50 ye-propofol induction dose ngaphandle kwemiphumela emibi kakhulu, okulingana nomphumela wedosi engu-1.5 mg/kg.Sincoma u-1.0 mg/kg njengomthamo ophelele.Amagama angukhiye: i-lidocaine, i-propofol, i-uterine aspiration, umthamo osebenzayo we-median Isamba semithamo ye-propofol, isikhathi sokuvuka, nezenzakalo ezimbi zarekhodwa.Imiphumela: I-ED50 (isikhathi sokuzethemba esingu-95%) ye-propofol yayiphansi kakhulu kumaqembu L1.0 kanye ne-L1.5 kuneqembu L0 (1.6 [1.5-1.7] mg/ kg kanye ne-1.8 [1.6-1.9] mg/kg, ngokumelene ne-2.4 [2.3–2.5] mg/kg, ngokulandelana, p1.0 kanye ne-L1.5 (p> 0.05) .5 kune-L0 (2.8 [2.6– 3.0] mg/kg vs 2.4 [2.3– 2.5] mg/kg; p1 I-.0 kanye ne-L1.5 yayiphansi kunaleyo emaqenjini u-L0 no-L0.5 (i-p0.5 yayinkulu kunaleyo eseqenjini L0 (p0.5 yayinkulu kunaleyo emaqenjini L0 kanye ne-L1.0 (p Isiphetho: Ezigulini ezidlule Isifiso se-uterine se-trimester yokuqala, i-lidocaine ye-intravenous 1.0 mg/kg ngaphambi komjovo we-propofol yanciphisa kakhulu i-ED50 yomthamo wokungeniswa kwe-propofol ngaphandle kwemiphumela emibi kakhulu, okulingana nomphumela we-dose ye-1.5 mg/kg.Isamba semithamo ye-propofol, isikhathi sokuvuka, nezenzakalo ezimbi zarekhodwa.Imiphumela: I-ED50 (isikhawu sokuzethemba esingu-95%) ye-propofol yayiphansi kakhulu kumaqembu e-L1.0 ne-L1.5 kuneqembu le-L0 (1.6 [1.5-1, 7] mg/ml).кг kanye no-1,8 [1,6–1,9] мг/кг по сравнению с 2,4 [2,3–2,5] мг/кг соответственно, p1,0 kanye ne-L1,5 (p>0,05 ), однако, как ни удивительно, ED50 была значительно выше в группе L0. kg kanye ne-1.8 [1.6-1.9] mg / kg ngokumelene ne-2.4 [2.3-2.5] mg / kg, ngokulandelana, i-p1.0 ne-L1.5 (p> 0.05), noma kunjalo, ngokumangalisayo, i-ED50 yayiphakeme kakhulu eqenjini le-L0 .I-0.5 kune-L0 (2.8 [2.6-3.0] mg/kg vs. 2.4 [2.3-2.5] mg/kg; p1.0 kanye ne-L1.5 yayiphansi kunamaqenjini L0 no-L0.5 (p0.5 mkhulu kunamaqenjini I-L0 ne-L0.5) eqenjini L0 (p0.5 yayinkulu kunamaqenjini L0 kanye ne-L1.0 (p Isiphetho: ezigulini ezithola i-aspiration isibeletho ku-trimester yokuqala, ukuphathwa kwe-lidocaine nge-intravenous ngethamo lika-1.0 mg/kg ngaphambili umjovo we-propofol wehlise kakhulu i-ED50 yomthamo wokungenisa we-propofol)) ngaphandle kwemiphumela emibi kakhulu, okulingana nomphumela womthamo ongu-1.5 mg/kg.Sincoma u-1.0 mg/kg njengomthamo ophelele. , ukulangazelela kwesibeletho, kusho umthamo osebenzayoIsamba somthamo we-propofol, isikhathi sokuvuka, nezenzakalo ezimbi zarekhodwa.Umthamo: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.9mg/1mg/1.8mg/1.8mg/1. 2.4 [2.3–2.5] mg/kg;p1.0 和L1.5 (p> 0.05)。然而，令人惊讶的是，L0 组的ED50 显着更高.5 比L0 (2.3 [2.0]– 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 结论（p) : 在 接受 妊娠 早期 子 宫 抽 的 的 患者 中 中 中 中 前 前前 静脉静脉的效果。我們推荐1.0 mg/kg作為最剂量。关键說：利多卡因、丙泊酚、子宫抽吸、中位有效剂量Isilinganiso: L1.0 和L1.5 组异丙酚的ED50（95% L0 mg/kg vs 2.4 [2.3– 2.5] mg/kg患者 中 丙泊 酚 注射 前 静脉 利多卡因 注射 利多卡因 注射 利多卡因 注射 注射效果。我們推荐1.0 mg/kgImiphumela: I-ED50 (isikhathi sokuthembela esingu-95%) se-propofol ku-L1.0 namaqembu e-L1.5 yayiphansi kakhulu kuneqembu le-L0 (1.6 [1.5-1.7] mg/kg kanye ne-1.8 [1, 6-1.9] mg /kg).кг соответственно 2,4 [2,3–2,5] мг/кг, p1,0 kanye L1,5 (p>0,05).Однако, как ни удивительно, ED50 была значительно вышеп епе перу5 в Lг0руп. ku-группе L0 (2,8 [2,6–2,6–2,6]). kg, ngokulandelana, 2.4 [2.3-2.5] mg/kg, p1.0 kanye ne-L1.5 (p>0.05).Kodwa-ke, ngokumangalisayo, i-ED50 yayiphezulu kakhulu eqenjini le-L0.5 kuneqembu L0 (2.8 [2.6-2.6-2.6]).3.0] mg/kg vs. 2.4 [2.3-2.5] mg/kg;i-p1.0 ne-L1.5 ibiphansi kunamaqenjini L0 no-L0.5 (p0.5 inkulu kunamaqenjini L0 (p0.5 inkulu kune-L0 kanye namaqembu angu-L1. 0 (p Iziphetho). : Ezigulini zesifazane, Ezigulini Ukuthola i-uterine trimester yokuqala, i-intravenous lidocaine 1.0 mg/kg ngaphambi komjovo we-propofol yehlise kakhulu i-ED50 yomthamo wokungeniswa kwe-propofol ngaphandle kwemiphumela emibi kakhulu, okulingana nomthamo we-1.5 mg/kg Sincoma u-1.0 mg/kg kg njengomthamo ofanele Amagama angukhiye: i-lidocaine, i-propofol, i-uterine aspiration, kusho umthamo osebenzayo
Ngenxa yokuthi i-propofol inohhafu wempilo emfushane kakhulu kuneminye imithi, i-propofol ivamise ukusetshenziswa njengesibulala-zinzwa esifakwa emthanjeni ukuze inikeze ukuthomalalisa phakathi nokuhlinzwa kwesiguli esingalalisiwe.I-1,2 Kodwa-ke, i-sedation enezilinganiso eziphezulu kuphela ze-propofol ihlotshaniswa nemiphumela emibi yokuphefumula nokujikeleza kwegazi.Imithamo ephakeme ye-propofol yandisa ingozi yokuphelelwa umoya, ukuwohloka komzila womoya ophezulu, kanye nomfutho wegazi ophakeme;3-7 kuyilapho imithamo ephansi ibangela ukulaliswa okwanele.I-Propofol ihlangene nezinye izidakamizwa inciphisa ingozi yezinkinga zokuphefumula nokujikeleza kwegazi futhi inikeza umphumela ophephile futhi owanelisayo wokulalisa.Ngakho-ke, kunesidingo se-adjuvant ephumelelayo yokunciphisa impendulo yokuhlinzwa nokunciphisa isidingo se-propofol.Eminyakeni yamuva, kokubili i-midazolam ne-dexmedetomidine isetshenziswe ekuhlinzeni iziguli ngaphandle, kodwa uhhafu wempilo ye-midazolam yinde, ukufakwa kwe-dexmedetomidine kuhamba kancane, futhi umuthi ukhulu, ngakho ukusetshenziswa kulinganiselwe.8.9
I-Lidocaine iyi-anesthetic yendawo esetshenziswa kabanzi emisebenzini yomtholampilo.Izifundo ze-10 zangaphambilini zithole ukuthi i-lidocaine ye-intravenous ingathuthukisa umphumela wokuqeda i-anesthesia esekelwe e-propofol.11-15 Ezinye izinzuzo ze-perioperative ze-lidocaine emithanjeni zihlanganisa ubuhlungu obuncishisiwe bomjovo we-propofol, ukunciphisa imfuneko ye-opioid, ukusheshisa ukutakula kokusebenza kwamathumbu ngemva kokuhlinzwa, nokuncipha kwesigameko sobuhlungu obungapheli ngemva kokuhlinzwa.16-19 I-lidocaine ye-intravenous ine-half-life emfushane (90-120 min), futhi ukugxila kwayo kwegazi okubikwe ezifundweni zemitholampilo kwahlala ngaphansi kokugxila okunobuthi (> 5 µg /mL) .20,21 Foo et al batusa eziqondisweni zabo zokuvumelana ezisanda kushicilelwa ukuthi uma i-lidocaine efakwa emthanjeni isetshenziswa, umthamo wokuqala ongekho ngaphezu kwe-1.5 mg/kg ebalwe kusetshenziswa isisindo somzimba esifanelekile sesiguli wawuphephile.21 Ucwaningo olwenziwa nguLili et al kakade kufakazele ukuthi ukuphathwa kwe-bolus intravenous lidocaine 1.5 mg / kg ngaphambi kokungeniswa kwe-anesthesia kuholele ekunciphiseni kwe-36% ku-ED50 ye-propofo. Лидокаин является широко используемым местным анестетиком в клинической практике.Предыдущие иссследования показали, что внутривенное введение лидокаина может усиливать седативный эффект анестезии на основе пропофоф.ускоренное восстановление функции желудочно-кишечного тракта после операции и снижение частоты послеоперационной хронической боли.16–19 Внутривенный лидокаин имеет короткий период полувыведения (90–120 мин), а его концентрация в крови, зарегистрированная в клинических исследованиях, оставалась ниже токсической концентрации (> 5 мкг)./мл)20,21 Foo et al.в своих недавно опубликованных согласованных рекомендациях рекомендовали, чтобы при внутривенном введении лидокаина начальная доза не более 1,5 мг/кг, рассчитанная с использованием идеальной массы тела пациента, была безопасной.21 Исследование Lili и др.уже доказали, что болюсное внутривенное введение лидокаина в дозе 1,5 мг/кг перед индукцией анестезии приводит книж60 %.利多卡 因 是 临床 实践实践包括 减轻 异丙酚 注射 疼痛, 减少 阿片类 药物药物, 术后术后 功能功能 恢复, 术后术后 疼痛 发生率发生率. 16-19 发生率发生率. 16-19 静脉静脉 注射利多卡注射利多卡 半衰期注射利多卡因 (90-120 短的 其 血液 浓度 仍 低于 毒性 浓度 (5 μg /ml).20,21 foo 等 在 在他们 发表新超过 1.5 mg/kg 是安全的。21 Lili 的一项研究等人已经证明，在麻醉诱导前静脉推注利多卡時 3.5 mg/利多卡 因 临床 实践 中 广泛 使用 的 局部 局部. 10 先前先前 发现, 静脉静脉 因 可以增强 酚增强注射 减少 阿片类 药物 药物 需求, 术术 胃肠 功能 功能, 术术 慢性 疼痛疼痛 发生率发生率. 16-19 发生率发生率. 16-19 静脉静脉. 16-19 静脉静脉 因半衰期 (90-120 研究 (90-13 研究 研究研究毒性 浓度 ((> 5 аК.20.21 Foo 等等 他们 发表他们 的指南如果 注射 利多卡因 患者 理想 计算 的 不 不 不 不 к К不/кг 可 丙泊 酚 的 ed50 降低 36%l 用 于 减轻 宫腔镜 手术 患者 对 宫颈 的 的 反应 反应 反应 等 等 等 还 等 к к 注射 注射 患者 患者 患者 的 患者 患者 患者 可 期间 к而 而 而 而 患者 检查 异丙酚 诱导剂量 的 的 , , 不会显着影响血嵁光和
Ngakho-ke, lolu cwaningo luhlose ukuhlola umphumela wemithamo ehlukene ye-lidocaine emithanjeni ku-ED50 kanye ne-ED95 yemithamo ye-propofol-inducing ngesikhathi se-trimester yokuqala ye-uterine aspiration, kanye nokunquma umthamo ophelele, okuyinto, ngokwazi kwethu, engakaze ifundwe. ezifundweni ezedlule..
Ngemva kokuphothula idizayini yalolu cwaningo lomtholampilo, seqa ukubuyekezwa kwezimiso zokuziphatha kwangaphambilini kweSibhedlela Sesibili Sase-West China, futhi esilandelayo sisasele izinyanga ezimbalwa.Ngakho-ke, siye safuna ukubuyekezwa kwezimiso zokuziphatha eKomidini Lezimiso Zokuziphatha Lase-China Clinical Trials, ikomiti elizimele lezimiso zesikhungo elihlelwe i-China Clinical Trials Registration Center.Le phrothokholi yocwaningo yamukelwe iKomidi Lokuziphatha le-Chinese Clinical Trials Registry (ChiECCRCT20210401) futhi ibhaliswe ne-Chinese Clinical Trials Registry (ChiCTR2100049263).Ucwaningo lwenziwe ngokuhambisana neSimemezelo sase-Helsinki kusukela ngoSepthemba 2021 kuya kuMeyi 2022, futhi sithole imvume ebhaliwe enolwazi oluvela kubahlanganyeli bocwaningo abayi-100 ngaphambi kokuqala kocwaningo.
Lolu cwaningo okulindelwe lwenziwa ezigulini zesifazane okuhlelwe ukuthi zihlolwe i-hysteroscopy ye-trimester yokuqala ngaphansi kwe-anesthesia evamile eSibhedlela saseSichuan University West China Second.Ucwaningo lwaluhlanganisa iziguli ezinesimo somzimba se-ASA I noma II, ezineminyaka engu-18-50 futhi zizila ukudla amahora angu-6 (okuqinile) namahora angu-2 (uketshezi) ngaphambi kokuhlinzwa. Izindlela zokukhishwa zazimi kanje: iziguli ezine-body mass index (BMI)> 28 kg / m2 noma i-BMI <18 kg / m2; Izindlela zokukhishwa zazimi kanje: iziguli ezine-body mass index (BMI)> 28 kg / m2 noma i-BMI <18 kg / m2; Критерии исключения были следующими: пациенты с индексом массы тела (ИМТ) >28 кг/м2 или ИМТ <18 кг/м2; Izindlela zokukhishwa zazimi kanje: iziguli ezine-body mass index (BMI)> 28 kg / m2 noma i-BMI <18 kg / m2;排除标准如下：体重指数（BMI）>28 kg/m2或BMI<18 kg/m2的患者；排除标准如下：体重指数（BMI）>28 kg/m2或BMI<18 kg/m2的患者； Критерии исключения: пациенты с индексом массы тела (ИМТ) > 28 кг/м2 или ИМТ < 18 кг/м2; Izindlela zokukhishwa: iziguli ezine-index mass body (BMI)> 28 kg/m2 noma i-BMI <18 kg/m2; iziguli ezinesisindo somzimba <40 kg; iziguli ezinesisindo somzimba <40 kg; пациенты с массой тела <40 кг; iziguli ezinesisindo esingaphansi kwama-40 kg;体重<40公斤的患者；体重<40公斤的患者； Пациенты с массой тела < 40 кг; Iziguli ezinesisindo esingu-<40 kg;Iziguli ezinokubelethwa kwesitho sangasese sowesifazane kanye nomlando wokuvuleka komlomo wesibeletho phakathi nezinyanga eziyisi-6;iziguli ezingazwani nezinzwa zendawo, i-propofol, i-fentanyl, noma ezinye izidakamizwa ezihlobene nalolu cwaningo;iziguli ezinokwehluleka okukhulu kwe-hepatic ne-renal, izifo ze-endocrine, iziguli ezinokuphazamiseka kwe-metabolic, izifo zenhliziyo, izifo zesimiso sokuphefumula noma izifo zesimiso sezinzwa esiyinhloko Ukusetshenziswa isikhathi eside kwama-sedative, ama-analgesics, izidakamizwa ezingathinta umzimba we-anesthetics wendawo noma iziguli phakathi nezinsuku eziyi-7 Zamukele okunye ukuhlola phakathi nezinyanga ezi-3 ngaphambi kocwaningo Izidakamizwa noma iziguli ezibambe iqhaza kwezinye izivivinyo zomtholampilo;iziguli eziluthwe utshwala noma izidakamizwa zokungcebeleka;iziguli ezinezikolo ze-Mallampati III-IV.Bonke ababambiqhaza bazisiwe ngenjongo yocwaningo.
Kafushane, iziguli ze-100 zihlelwe ngokungahleliwe zibe ngamaqembu L0, L0.5, L1.0, kanye ne-L1.5 ngokuvumelana nokulandelana okungahleliwe okwenziwe ngekhompyutha nosayizi webhulokhi we-4. Inombolo eyingqayizivele ivalwe emvilophini e-opaque.Odokotela ababulala izinzwa abalungisa futhi banikeze izidakamizwa bayayazi imisebenzi yeqembu.Abacwaningi, iziguli, odokotela abahlinzayo, nabahlengikazi abaqoqa imininingwane babengaboni kahle.
Azikho ezinye izidakamizwa ezanikezwa ngaphambi kokufakwa kwe-anesthesia.I-cannula engu-22 gauge yafakwa emthanjeni kwase kuqalwa ukumnika kwe-lactate ka-Ringer (2 ml/kg/h).Lapho singena ekamelweni lokusebenza, isiguli sanikezwa umoya wokuphefumula umoya nge-mask ngesilinganiso se-10 L / min imizuzu engu-3 ngaphambi kokungeniswa, futhi umfutho wegazi ohlaselayo, i-electrocardiogram, izinga lokuphefumula, kanye ne-peripheral capillary oxygen saturation (SpO2) ihlolwe. kuze kudedelwe isiguli.kusuka ku-anesthesia.futhi yadluliselwa esikhathini esingemva kokuhlinzwa emnyangweni we-anesthesia.I-SpO2, izinga lokushaya kwenhliziyo (HR) kanye nomfutho wegazi ohlaselayo kwabhalwa ezikhathini ezintathu ezilandelayo: ngesikhathi sokulungiselela ukufakwa kwe-anesthesia (T0), ekupheleni kokufakwa kwe-anesthesia (T1), ekupheleni kokunwetshwa komlomo wesibeletho. (T2).Wonke amalungiselelo alungiselelwa ekamelweni lokushisa.izinga lokushisa, ligcinwe futhi lisetshenziswe ngokushesha.I-Lidocaine (i-Sinopharm Rongsheng Pharmaceutical Co., Ltd.) 0.5 mg/kg, 1.0 mg/kg kanye ne-1.5 mg/kg ihlanjululwe yaba ngu-10 ml ngosawoti esirinjini engu-10 ml.Lungiselela futhi umthamo olinganayo kasawoti esipeni esingu-10 ml.Isingeniso sokubulala izinzwa saqalwa ngomjovo owodwa we-bolus we-fentanyl 1.0 μg/kg (Yichang Renfu Pharmaceutical Co., Ltd., China).Ngemva komzuzu, i-lidocaine elungisiwe noma i-saline isetshenziswa njengoba kunqunyiwe cishe imizuzwana engu-30, bese i-propofol (i-Corden Pharma SPA, e-Italy) inikezwa kuzo zonke iziguli ngesilinganiso esingu-0.4 ml/s.Isiguli sokuqala eqenjini ngalinye sathola i-propofol 2.0 mg/kg.Ezigulini ezalandela, umthamo we-propofol wanda noma wehla ngo-0.2 mg / kg, kuye ngokuthi impendulo yesiguli sangaphambilini.I-Modified Observer Alertness/Sedation Rating Scale (MOAA/S) yasetshenziswa ukuze kuhlolwe ukujula kokupholisa.24 Isikali se-MOAA/S singamaphuzu angu-6 futhi sichazwa ngokuthi 5: igama elibiza kalula ngethoni evamile;4: ukusabela kokulala egameni elishiwo ngethoni evamile;3: kuphela ngempendulo ephezulu kanye/noma ephindaphindayo ngemva kokubiza igama;2: ukusabela kuphela ekukhuthazeni okuncane noma ukuzamazama;I-1: impendulo kuphela ekuvinjweni okubuhlungu kwe-trapezius muscle;0: akukho mpendulo ekufinyezweni kwemisipha ye-trapezius. Ngemuva kokuthi amaphuzu e-MOAA/S abe <1, udokotela ohlinzayo wavunyelwa ukuba aqale ukubekwa kwe-speculum yesitho sangasese sowesifazane, okwakubonisa ukuqala kokuhlinzwa. Ngemuva kokuthi amaphuzu e-MOAA/S abe <1, udokotela ohlinzayo wavunyelwa ukuba aqale ukubekwa kwe-speculum yesitho sangasese sowesifazane, okwakubonisa ukuqala kokuhlinzwa. После того, как оценка MOAA/S была <1, хирургу было разрешено начать установку вагинального зеркала, что сигнализировало опцера о началение. Lapho amaphuzu e-MOAA/S esengu-<1, udokotela ohlinzayo wavunyelwa ukuba aqale ukufaka i-speculum yesitho sangasese sowesifazane, ebonisa ukuqala kokuhlinzwa.在MOAA/S 评分<1 后，外科医生被允许开始放置阴道窥器，這标志着手术的开始.I-MOAA/S После того, как оценка MOAA/S <1, хирургу было разрешено начать установку вагинального зеркала, что ознаменовало начало процедур. Lapho amaphuzu e-MOAA/S esengu-<1, udokotela ohlinzayo wavunyelwa ukuba aqale ukufaka i-speculum yesitho sangasese sowesifazane, ephawula ukuqala kwenqubo.Yonke imisebenzi yenziwa udokotela ohlinzayo ofanayo.Umphumela wawubhekwa njengokungavumelekile uma i-MOAA/S ingu-≥1 ngemva komthamo wokuqala we-propofol noma uma ukunyakaza kwezitho kubonwa kusukela ekuqaleni kuya ekuvulekeni komlomo wesibeletho;ngaphandle kwalokho, umphumela wawubhekwa njengobalulekile.Ezimweni ezingasebenzi, umthamo we-propofol wanda ngo-0.2 mg/kg ezigulini ezalandela.I-Propofol yancishiswa ngo-0.2 mg/kg ezigulini ezalandela ezimweni ezisebenzayo.Uma i-MOAA/S ingu-≥1 noma ukunyakaza kwezitho kubonwa ngesikhathi sokuhlinzwa, i-propofol 0.5–1.0 mg/kg inikezwa ngokwesidingo somtholampilo.Ngemuva kokufakwa kwe-anesthesia, uma isikhathi se-apnea sidlula iminithi elingu-1, kwakuchazwa njengokudangala kokuphefumula kanye nokungenisa umoya ngomshini kuze kubuyiselwe ukuphefumula okuzenzakalelayo.Uma ukuvinjelwa kwendlela yokuphefumula ephezulu kubonakala, phakamisa umhlathi ongezansi ukuze kungene umoya. Uma i-SpO2 <92%, i-hypoxia yachazwa futhi inqubo yamiswa, futhi kwafakwa umoya wemaski wobuso osizwayo ukuze kujwayeleke ukugcwala komoyampilo. Uma i-SpO2 <92%, i-hypoxia yachazwa futhi inqubo yamiswa, futhi kwafakwa umoya wemaski wobuso osizwayo ukuze kujwayeleke ukugcwala komoyampilo. I-При SpO2 <92% определяли гипоксию и процедуру прекращали, а для нормализации сатурации кислородом применяли вспомогательюсья вспомогательюский вспомогательзенуки применяли вспомогательюский применяли вспомогательюсью вспомогательзенуву. Ku-SpO2 <92%, i-hypoxia yanqunywa futhi inqubo yamiswa, futhi isisetshenziswa sokungenisa umoya semaski sobuso sasetshenziswa ukwenza kujwayelekile ukugcwala komoyampilo.如果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和度正常化。如果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和度正常化。 I-Если SpO2 < 92%, ikhiphe i-гипоксию ne-прекратите операцию, i-также примените искусственную вентиляцию легких сномощьюки маский маские для операцию. Uma i-SpO2 <92%, inquma i-hypoxia bese inqamula ukuhlinzwa, futhi ikhiphe umoya ngemaski ukuze wenze ukugcwala komoyampilo kujwayelekile. Uma i-HR yayingaphansi kwe-50 beats/min, i-atropine 0.5 mg yayisetshenziswa. Uma i-HR yayingaphansi kwe-50 beats/min, i-atropine 0.5 mg yayisetshenziswa. Если ЧСС <50 уд/мин, вводили атропин 0,5 мг. Uma izinga lokushaya kwenhliziyo lingaphezu kwama-50 bpm, i-atropine 0.5 mg yayisetshenziswa.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. Uma izinga lokushaya kwenhliziyo lingaphezu kuka-50 bpm, nikeza i-atropine engu-0.5 mg. I-Hypotension yachazwa ngokuthi i-SBP, i-diastolic blood pressure (DBP), noma i-arterial pressure (MAP) yehle ngaphezu kwe-20% yesisekelo sokuqala, noma i-SBP<80 mmHg. I-Hypotension yachazwa ngokuthi i-SBP, i-diastolic blood pressure (DBP), noma i-arterial pressure (MAP) yehle ngaphezu kwe-20% yesisekelo sokuqala, noma i-SBP<80 mmHg. I-Гипотензия определялась как снижение САД, диастолического артериального давления (ДАД) или среднего артериального давления (САД) больше САД % САД % САД % САД % САД) I-Hypotension yachazwa njengokuncipha kwe-SBP, i-diastolic blood pressure (DBP), noma i-arterial pressure (MAP) engaphezu kuka-20% yesisekelo, noma i-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%, i-SBP<80 mmHg. I-Гипотензию определяли как снижение более чем на 20% от исходного уровня САД, диастолического артериального давлее чем Артериального давления (ДАД) или слезе. I-Hypotension yachazwa njengokwehla okungaphezu kuka-20% kusukela kwesisekelo ku-SBP, umfutho wegazi we-diastolic (DBP), noma umfutho wegazi omaphakathi (MAP), noma i-SBP <80 mmHg.Uma i-hypotension ivela, i-0.2-0.4 mg ye-metahydroxylamine noma i-5-10 mg ye-ephedrine ilawulwa, kuye ngokuthi isimo.Isamba sesilinganiso se-propofol, isikhathi sokusebenza, nesikhathi sokuthola kabusha ekupheleni komsebenzi kwarekhodwa.I-Myoclonus kanye nemiphumela engemihle yemithi ebulala izinzwa yendawo nayo ibikiwe, njenge-tinnitus, ukuba ndikindiki kweperioral, nokushaya kwenhliziyo okulandela i-propofol.
Iziphetho eziyinhloko kwakuyi-ED50 ne-ED95 yomthamo wokungeniswa kwe-propofol.Iziphetho zesibili kwakuyinani eliphelele le-propofol, isikhathi sokululama ngemuva kokuhlinzwa, ukucindezeleka kokuphefumula, ukuvinjelwa kwendlela yokuphefumula ephezulu, i-hypoxia, i-bradycardia, i-hypotension, ne-postpropofol myoclonus.
Ukuzimela kanye nokusatshalaliswa okungaziwa kwedatha efundwe ngendlela elandelanayo esuka phezulu iye phansi kwenza kube nzima ukwenza imithetho eqinile engokomcabango yokubala usayizi wesampula.25 Usayizi wesampula wanqunywa umthetho wokumisa.Iziguli kufanele zibhaliswe ngaphambi kokuthi okungenani amapheya ayisithupha emiphumela engavumelekile aguqulelwe emiphumeleni evumelekile.Ucwaningo lokulingisa lubonise ukuthi, ezimweni eziningi, ukufakwa okungenani kweziguli ze-20-40 kunganikeza isilinganiso esizinzile somthamo ohlosiwe.Ezinye izivivinyo zokubulala izinzwa ezisebenzisa le ndlela ngokuvamile zibandakanya iziguli ezingama-20-40.I-26,27 Esifundweni sethu, iqembu ngalinye lalihlanganisa iziguli ze-25, ezanele ukuhlaziya izibalo.
I-SPSS 26.0 (IBM Inc., Armonk, NY, USA) yasetshenziswa ukuhlaziya imiphumela.Ukuhlolwa kwe-Shapiro-Wilk kusetshenziswe ukunquma ukusatshalaliswa okuvamile kwedatha.Okuguquguqukayo okusatshalaliswa okuqhubekayo okuqhubekayo kwavezwa njengokuchezuka okushiwo ± okujwayelekile futhi kuqhathaniswa phakathi kwamaqembu asebenzisa i-ANOVA yendlela eyodwa.Idatha engasatshalaliswanga ngokujwayelekile yethulwa njenge-median (ububanzi be-interquartile) futhi yaqhathaniswa kusetshenziswa ukuhlolwa kwesamba sezinga le-Wilcoxon.Idatha yezigaba zethulwa njengo-n (%) futhi ihlaziywa kusetshenziswa ukuhlolwa kwe-chi-square.I-ED50 (95% CI) ye-propofol ibalwe njengencazelo yephoyinti eliphakathi le-zero ebalulekile yokuwela kusetshenziswa i-ANOVA yendlela eyodwa nendlela ye-Bonferroni ukuze kuqhathaniswe phakathi kwamaqembu.I-ED95 (95% CI) yalinganiselwa kusetshenziswa ukuhlehla okungenzeka. Kukho konke ukuhlaziya, i-p<0.05 ibhekwe njengebonisa umehluko obalulekile ngokwezibalo. Kukho konke ukuhlaziya, i-p<0.05 ibhekwe njengebonisa umehluko obalulekile ngokwezibalo. Для всех анализов считалось, что p<0,05 указывает на статистически значимые различия. Kukho konke ukuhlaziya, i-p<0.05 ithathwe njengebonisa umehluko obalulekile ngokwezibalo.对于所有分析，p<0.05 被认為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. Kukho konke ukuhlaziya, i-p<0.05 ithathwe njengebonisa umehluko obalulekile ngokwezibalo.
Ziyi-121 iziguli ezibhalisiwe futhi zahlolwa.Kulezi, iziguli ze-100 zihlelwe ngokungahleliwe zibe ngamaqembu e-4 futhi zifakwe ekuhlaziyweni kokugcina (Umfanekiso 1).Izici eziyisisekelo zamaqembu amane eziguli, kuhlanganise neminyaka, i-BMI, izinga lenhliziyo (T0), i-SBP (T0), i-DBP (T0) ne-SBP (T0), ayizange ihluke kakhulu (Ithebula 1).
Ukulandelana okuphezulu phansi okubonisa umthamo kanye nempendulo yesiguli kuboniswa ngezansi (Umfanekiso 2).Imithamo emaphakathi yokufakwa kwe-propofol emaqenjini e-L0, L0.5, L1.0, kanye ne-L1.5 yayingu-2.3±0.2, 2.7±0.3, 1.6±0.2, kanye no-1.7±0.2 mg/kg, ngokulandelana.Emkhiwaneni.I-3 ibonisa ukuhlaziywa kwempendulo yomthamo we-lidocaine ne-propofol emaqenjini amane eziguli.Ithebula 2 libonisa i-ED50 kanye ne-ED95 (95% CI) ye-propofol yezingalo ezine, ngokusekelwe ku-oda lokukhuphuka phansi kwe-Dixon-Massey kanye nokuhlehla kwamathuba, ngokulandelana. I-ED50 ye-propofol emaqenjini L1.0 kanye ne-L1.5 yayingaphansi kakhulu kunaleyo eqenjini 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). I-ED50 ye-propofol emaqenjini L1.0 kanye ne-L1.5 yayingaphansi kakhulu kunaleyo eqenjini 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).I-ED50 ye-propofol emaqenjini e-L1.0 ne-L1.5 yayiphansi kakhulu kuneqembu le-L0 (1.6 [1.5-1.7] mg / kg; 1.8 [1.6-1.9] mg / kg).kg uma kuqhathaniswa no-2.4 [2.3–2.5] mg/kg).кг кг, р<0,001). kg kg, p<0.001). I-L1.0 ne-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/ p <0.001). L0, p <0.001).I-propofol ED50 yayiphansi kakhulu ku-L1.0 namaqembu e-L1.5 kuneqembu le-L0 (1.6 [1.5-1.7] mg / kg; 1.8 [1.6-1.9] mg / kg).kg uma kuqhathaniswa no-2.4 [2.3–2.5] mg/kg)./кг кг, p <0,001). /kg kg, p <0.001). Inani le-ED50 laliphezulu eqenjini L0.5 kuneqembu L0 (2.8 [2.6-3.0] mg/kg vs 2.4 [2.3–2.5] mg/kg, p<0.05). Inani le-ED50 laliphezulu eqenjini L0.5 kuneqembu 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/кг против 2,4 [2,3–2,5] мг/кг, p<0 ,05). I-ED50 yayiphezulu eqenjini le-L0.5 kuneqembu le-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). I-Группа L0,5 имела более высокие значения ED50, чем группа L0 (2,8 [2,6–3,0] мг/кг против 2,4 [2,3–2,5] мг/кг, p<0, 05). Iqembu le-L0.5 lalinamanani aphezulu e-ED50 kuneqembu le-L0 (2.8 [2.6–3.0] mg/kg vs. 2.4 [2.3–2.5] mg/kg, p<0, 05). Awukho umehluko obalulekile ku-ED50 ye-propofol phakathi kwamaqembu L1.0 kanye ne-L1.5 (p>0.05). Awukho umehluko obalulekile ku-ED50 ye-propofol phakathi kwamaqembu L1.0 kanye ne-L1.5 (p>0.05). Не было существенной разницы ku-ED50 пропофола между группами L1.0 kanye ne-L1.5 (p>0,05). Awukho umehluko obalulekile ku-propofol ED50 phakathi kwamaqembu e-L1.0 ne-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 ku-ED50 пропофола между группой L1.0 kanye ne-группой L1.5 (p>0,05). Awukho umehluko obalulekile ku-propofol ED50 phakathi kweqembu le-L1.0 neqembu le-L1.5 (p>0.05).
Ithebula 2 ED50 kanye ne-ED95 (95% CI) yamaqembu amane e-propofol asekelwe ekuhlelweni okuphezulu naphansi kwe-Dixon-Massey kanye nokuhlehla kwe-Probit
Umfanekiso 2 Dixon phezulu naphansi emaqenjini amane.“●” kusho okuvumelekile, “○” kusho okungavumelekile.
Kwakungekho mehluko obalulekile phakathi kwamaqembu esikhathini sokuhlinzwa nesikhathi sokuvuka njengoba kubhalwe kuThebula 3 (p>0.05). Kwakungekho mehluko obalulekile phakathi kwamaqembu esikhathini sokuhlinzwa nesikhathi sokuvuka njengoba kubhalwe kuThebula 3 (p>0.05). Не было никаких существенных различий между группами в продолжительности операции и времени пробуждения, как указано в 3бли>0. Kwakungekho mehluko obalulekile phakathi kwamaqembu ngesikhathi sokusebenza kanye nesikhathi sokuvuka, njengoba kuboniswe kuthebula lesi-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）,见表3. Не было существенной разницы во времени работы и времени пробуждения между группами (p>0,05), как показано в таблице 3. Awukho umehluko obalulekile esikhathini somsebenzi nesikhathi sokuvuka phakathi kwamaqembu (p>0.05), njengoba kuboniswe kuThebula 3. Izilinganiso ezilinganiselwe ze-propofol ephelele edingekayo kukho konke ukuhlinzwa kwakukhulu kakhulu kumaqembu L0 kanye ne-L0.5 kunamanye amaqembu amabili (p<0.05, Ithebula 3). Izilinganiso ezilinganiselwe ze-propofol ephelele edingekayo kukho konke ukuhlinzwa kwakukhulu kakhulu kumaqembu L0 kanye ne-L0.5 kunamanye amaqembu amabili (p<0.05, Ithebula 3). Средние дозы общего пропофола, необходимые для всей операции, были значительно выше в группах L0 kanye L0,5, чем 0, плика 0, группах L0 kanye L0,5, чем 0, плика Izilinganiso zokulinganisa zengqikithi ye-propofol edingekayo kuwo wonke umsebenzi zaziphakeme kakhulu kumaqembu e-L0 ne-L0.5 kunamanye amaqembu amabili (p<0.05, Ithebula 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和L0.5 Средняя доза общего пропофола, необходимая для всей процедуры, была значительно выше в группах L0 and L0,5, чем 0, плика 0, 3, 5, 5, 5 Isilinganiso sesilinganiso sengqikithi ye-propofol edingekayo kuyo yonke inqubo sasiphezulu kakhulu kumaqembu e-L0 ne-L0.5 kunamanye amaqembu amabili (p<0.05, Ithebula 3). Bekungekho mehluko obalulekile phakathi kwamaqembu esenzekeni sokuvinjwa kwendlela yomoya ephezulu (p>0.05). Bekungekho mehluko obalulekile phakathi kwamaqembu esenzekeni sokuvinjwa kwendlela yomoya ephezulu (p>0.05). I-Существенных различий между группами по частоте возникновения обструкции верхних дыхательных путей не было (p>0,05). Ubengekho umehluko obalulekile phakathi kwamaqembu esehlakalweni sokuvinjwa kwendlela yomoya ephezulu (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). Awukho umehluko obalulekile ezenzakalweni zokuvinjwa kwendlela yomoya ephezulu phakathi kwamaqembu (p>0.05). Isigameko sokucindezeleka kokuphefumula eqenjini L0.5 sasisikhulu kunamaqembu L0 kanye ne-L1.0 (p <0.05). Isigameko sokucindezeleka kokuphefumula eqenjini L0.5 sasisikhulu kunamaqembu L0 kanye ne-L1.0 (p <0.05). I-Частота угнетения дыхания в группе L0,5 была выше, чем в группах L0 kanye L1,0 (p<0,05). Imvamisa yokucindezeleka kokuphefumula eqenjini le-L0.5 yayiphezulu kunamaqembu e-L0 ne-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）。 I-Частота угнетения дыхания в группе L0,5 была выше, чем в группах L0 kanye L1,0 (p<0,05). Imvamisa yokucindezeleka kokuphefumula eqenjini le-L0.5 yayiphezulu kunamaqembu e-L0 ne-L1.0 (p <0.05). Kwakungekho umehluko ophawulekayo phakathi kwamaqembu ekuveleni kwe-hypotension (p> 0.05), kodwa ukwehla kwe-SBP ngemva kokungeniswa kwe-anesthesia eqenjini L0.5 kwakukhulu kunalelo eqenjini L0 (p <0.01). Kwakungekho umehluko ophawulekayo phakathi kwamaqembu ekuveleni kwe-hypotension (p> 0.05), kodwa ukwehla kwe-SBP ngemva kokungeniswa kwe-anesthesia eqenjini L0.5 kwakukhulu kunalelo eqenjini L0 (p <0.01). Достоверных различий между группами по частоте гипотензии не было (p>0,05), но снижение САД после индукции анестезип 1,пшезип 1,прукции анестезип 1,пьшезип 1,прукции анестезип 5P Kwakungekho umehluko ophawulekayo phakathi kwamaqembu ezenzweni ze-hypotension (p> 0.05), kodwa ukwehla kwe-SBP ngemva kokufakwa kwe-anesthesia kwakukhulu eqenjini le-L0.5 kuneqembu le-L0 (p <0.01).低血压发生率组间差异无统计学意义（p>0.05），但L0.5组麻醉诱导后SBP丅L0険组（SBP丅L0険廄幉。低血压发生率组间差异无统计学意义（p>0.05），但L0.5组麻醉诱导后SBP丅L0険组）大SBP丅L0険组）但L0.5组麻醉诱导后SBP学意义（SBP丅L0険约廄. Не было существенной разницы в частоте гипотензии между двумя группами (p>0,05), но снижение САД после индукци плуппами (p>0,05), но снижение САД после индукци плуппами, 1, прукции 0, прукции анест, песни Kwakungekho umehluko ophawulekayo ezenzakalweni ze-hypotension phakathi kwamaqembu amabili (p> 0.05), kodwa ukunciphisa i-SBP ngemva kokufakwa kwe-anesthesia kwakukhulu eqenjini le-L0.5 kuneqembu le-L0 (p <0.01).Akekho noyedwa weziguli owaba ne-bradycardia ne-hypoxia.Asikho isiguli esibike isicanucanu, i-tinnitus, ukuba ndikindiki kweperioral, nokushaya kwenhliziyo.Isiguli #20 eqenjini L1.0 sakha i-myoclonus ebusweni ngemva komthamo wokuqala we-propofol 1.8 mg/kg, futhi isiguli #10 eqenjini L1.5 sathuthukisa i-myoclonus yobuso namaphethelo ngemva komthamo wokuqala we-propofol 1.4 mg/kg..I-Myoclonus iyama ngemva kwemizuzwana engu-30-60. Bekungekho mehluko obalulekile phakathi kwamaqembu ezehlakalweni ze-myoclonus (p>0.05). Bekungekho mehluko obalulekile phakathi kwamaqembu ezehlakalweni ze-myoclonus (p>0.05). Достоверных различий между группами по частоте миоклонуса не было (p>0,05). Bekungekho mehluko obalulekile phakathi kwamaqembu ezehlakalweni ze-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). Kwakungekho mehluko obalulekile emvamisa ye-myoclonus phakathi kwamaqembu (p>0.05).
Ngokwazi kwethu, lolu wucwaningo lokuqala oluzokwenzeka olukhombisa umphumela wemithamo ehlukene ye-lidocaine efakwa emthanjeni ku-ED50 kanye ne-ED95 yomthamo wokungenisa we-propofol ezigulini ezithola i-hysteroscopy ye-trimester yokuqala.Imiphumela yabonisa ukuthi ukuphathwa nge-intravenous kwe-lidocaine ngethamo lika-1.0 mg/kg ngaphambi komjovo we-propofol kunciphisa kakhulu i-ED50, ED95 kanye nenani eliphelele le-propofol, elilingana nomphumela womthamo we-1.5 mg/kg.Ngakho-ke sincoma umthamo ophansi we-1.0 mg/kg njengomthamo olungile wokwelashwa okungeziwe okusebenzayo kwe-anesthesia efakwa emthanjeni nge-propofol.Samangala lapho sithola ukuthi ukuphathwa kwe-intravenous kwe-0.5 mg / kg i-lidocaine kwandisa i-ED50 ye-propofol, okubonisa umphumela oyinkimbinkimbi we-lidocaine.
Ngenxa yesenzo sayo esisheshayo nokululama ngokushesha, i-propofol ivame ukusetshenziselwa ukuthulisa ezinqubweni zokuhlinza ngaphandle kweziguli.Kodwa-ke, imithamo ephezulu ye-propofol yandisa ingozi yokuphefumula umoya, ukuwohloka komzila womoya ophezulu, kanye ne-hypotension, kuyilapho imithamo ephansi iholele ekudambiseni okunganele.Ngakho-ke, kunesidingo se-adjuvant ephumelelayo yokunciphisa impendulo yokuhlinzwa nokunciphisa isidingo se-propofol.Eminyakeni yamuva nje, ucwaningo oluningi luye lwabonisa imiphumela ye-analgesic ye-lidocaine ye-intravenous, okuhlanganisa ukunciphisa ubuhlungu ngemva komjovo we-propofol, ukunciphisa izidingo ze-opioid, nokunciphisa ubuhlungu obungapheli ngemva kokuhlinzwa.Ezincomweni zabo zokuvumelana ezishicilelwe, uFoo et al.batusa ukuthi umthamo wokuqala ongeqi ku-1.5 mg/kg obalwe kusetshenziswa isisindo somzimba esifanele uphephe ku-lidocaine efakwa emthanjeni.Muva nje, uLiu et al.kanye no-Yu et al.wabonisa ukuthi ukuphathwa nge-intravenous kwe-lidocaine ngaphambi kokufakwa kwe-anesthesia kubangele ukuncipha kwe-ED50 ye-propofol ezigulini ze-gastroscopy kanye ne-hysteroscopy.Ngakho-ke, ucwaningo lwethu luhlose ukuhlola umphumela wemithamo ehlukene ye-lidocaine efakwa emthanjeni ku-propofol-induced ED50 kanye ne-ED95 phakathi ne-trimester yokuqala yokufisa kwesibeletho kanye nokunquma umthamo ofanele.Asibandakanyi iziguli ezinomlando wokubeletha kwesitho sangasese sowesifazane futhi ezazinokukhishwa komlomo wesibeletho phakathi nezinyanga ezingu-6 ngenxa yokuthi sasicabanga ukuthi iziguli ezinomlando wokubeletha komlomo wesibeletho noma umlando wokukhishwa komlomo wesibeletho zazinokuvuselela okuncane komlomo wesibeletho ngesikhathi sokuhlinzwa kokuhlinzwa kuneziguli ezingenawo umlando wokuvuleka komlomo wesibeletho.ukunwebeka komlomo wesibeletho wesiguli.28 Lokhu kungase kuholele emiphumeleni enembe kakhudlwana.
I-lidocaine ye-intravenous ine-half-life yemizuzu engu-5-8 kuphela, iqala embhedeni we-vascular futhi ingena ezicutshini ze-peripheral, kuqala ngezindawo zokufafaza okuphezulu (inhliziyo, amaphaphu, isibindi, i-spleen), bese ingena ezindaweni ze-hypoperfusion.izicubu ze-adipose nemisipha).10 Ocwaningweni lwethu, sinikeze i-lidocaine ngaphambi kokungeniswa kwe-propofol ukuze kugcinwe ukugxila kwayo ku-plasma ngaphakathi kwebanga elisebenzayo.Ngenxa yalokho, ukusetshenziswa kwe-1.5 mg/kg ye-lidocaine ngaphambi kwe-propofol kubangele ukuncipha kwe-ED50 ye-propofol ngo-26%, kanye ne-1.0 mg/kg i-lidocaine eholele ekunciphiseni kwe-30%.Le miphumela ihambisana naleyo ka-Liu no-Xu, okubonisa ukuthi i-lidocaine kule mithamo inemiphumela yokudambisa izinhlungu kanye ne-antihyperalgesic.Kodwa-ke, okumangazayo ukuthi i-ED50 yanyuswa nge-lidocaine ye-intravenous ngo-0.5 mg/kg, okuphakamisa ukuthi umphumela womthamo we-0.5 mg/kg ungase uhlehliswe nokuthi imithamo ephansi kakhulu ye-lidocaine efakwa emthanjeni ingase ihlotshaniswe nokusabela okubucayi kwe-hypersensitivity okuhlobene nokungezwani komzimba. injabulo.I-Lidocaine isebenza ngezinhloso eziningi zamangqamuzana ezihilelekile ku-nociception enzima futhi engapheli, kuhlanganise ne-N-methyl-D-aspartate (NMDA) kanye ne-muscarinic cholinergic (m1, m3) receptors, okuyizikhathi ze-100-1000 ezibucayi kunezinye izinhloso.20,29 I-NMDA, i-m1 kanye ne-m3 receptors zihlala zizwela ekugxilweni kwe-lidocaine ngaphansi kokugxilisa okubalulekile kwe-plasma emtholampilo.I-Lidocaine ivimbela ukusebenza kwama-receptors e-NMDA abantu ekugxilweni kwe-nanomolar ngokuvinjelwa okukhulu ebangeni le-millimolar, okuholela ekunciphiseni ubuhlungu.I-Lidocaine isebenza kuma-muscarinic cholinergic receptors ngendlela yokugxilisa ingqondo nesikhathi.Claes et al.kubonise ukuthi ukuphathwa nge-intravenous kwe-lidocaine ngemithamo ye-10 kanye ne-30 mg / kg kukhuphule ukukhululwa kwe-acetylcholine ye-intraspinal kanye ne-analgesia ephakathi nendawo ngokuvula ama-muscarinic receptors kumagundane, kodwa umthamo we-1 mg / kg we-lidocaine awuzange ukhulise kakhulu ukukhululwa kwe-acetylcholine ye-intraspinal.Ucwaningo lwe-30,31 luye lwabonisa nokuthi i-lidocaine ivimbela i-m1 kanye ne-m3 muscarinic receptors ekugxilweni okuphansi kakhulu kwe-nanomolar (IC50 ye-18 nM ye-m1 kanye ne-370 nM ye-m3).Ukwengeza, ukuchayeka isikhathi eside ku-lidocaine ku-IC50 kubangele ukuguqulwa kwe-biphasic kwe-m1 kanye ne-m3 receptors ngokuvinjelwa kokuqala okulandelwa amahora angu-8 kamuva ngokubonisa ukwanda.32 Ngakho, i-bolus yethu eyodwa yemithamo ephansi kakhulu ye-lidocaine engu-0.5 mg/kg ngaphandle kokuchayeka isikhathi eside ingase isebenze ngokuyinhloko ngokuvinjelwa kwe-m1 kanye ne-m3 receptors.Ukuvinjelwa kwe-m1 kanye ne-m3 receptors kwakuzwakala kakhulu, okungase kuchaze ukwanda kwe-ED50 eqenjini le-L0.5 esifundweni sethu.Kodwa-ke, esifundweni sethu, asizange silinganise ukuhlushwa kwe-lidocaine ku-plasma.Ucwaningo olwengeziwe nokuqinisekisa kuyadingeka ukuze kuqinisekiswe lokhu kucabanga.
Isilinganiso sesilinganiso sengqikithi ye-propofol edingekayo kuwo wonke umsebenzi sasiphezulu kakhulu kumaqembu e-L0 ne-L0.5 kunamanye amaqembu amabili.Imvamisa yokucindezeleka kokuphefumula eqenjini le-L0.5 yayiphezulu kunamaqembu e-L0 ne-L1.0.Ukuncipha kwe-SBP ngemva kokufakwa kwe-anesthesia eqenjini le-L0.5 kwakukhulu kuneqembu le-L0.Asikho nesisodwa isiguli esathola i-hypoxia, njengoba senza ukuphakamisa isilevu noma ukufaka umoya wemaski ngesikhathi esifanele.Umthamo okhuphukile we-propofol ephelele, imvamisa yokudangala kokuphefumula, kanye nokwehla komfutho wegazi we-systolic ngemva kokufakwa kwe-anesthesia eqenjini le-L0.5 nakho kuphakamise ukuthi imithamo ephezulu ye-propofol ingase yandise ingozi yokuphefumula nokucindezelwa kwegazi.Kwakungekho umehluko ezenzakalweni zezenzakalo ezimbi phakathi kwamaqembu L0, L1.0 kanye ne-L1.5.Kodwa-ke, uma kubhekwa idizayini yocwaningo lwethu, isilinganiso esimaphakathi se-propofol-inducing eqenjini ngalinye sasiseduze ne-ED50 kodwa ngaphansi kwe-ED95.Ngakho-ke, izigameko zezenzakalo ezimbi zingase zibe phezulu uma iziguli eziseqenjini le-L0 zenziwe nge-propofol ngesilinganiso se-ED95 (2.8 [2.6-3.2] mg / kg).Kodwa-ke, umphumela we-lidocaine ubangele i-ED95 ye-2.0 (1.9-2.4) mg/kg kanye ne-2.1 (1.9-2.4) mg/kg kumaqembu e-L1.0 kanye ne-L1.5, ngokulandelana, ngemithamo ephansi kakhulu.Ingxoxo engenhla ichaza ukuthi kungani sikholelwa ukuthi umphumela we-analgesic we-lidocaine ye-intravenous ngemithamo efanelekile futhi ngesikhathi esifanele uwusizo ekunciphiseni izinkinga ze-anesthesia ezibangelwa i-propofol.Esifundweni sethu, kwakungekho umehluko ophawulekayo ku-ED50, umthamo ophelele we-propofol, isikhathi sokuvuka, nezenzakalo ezimbi phakathi kwamaqembu e-L1.0 ne-L1.5.Ngakho-ke sincoma umthamo ophansi we-1.0 mg/kg IV lidocaine njengomthamo ofanele.
Kunemikhawulo ethile esifundweni sethu.Okokuqala, iziguli ezine-ASA I noma II kuphela ezifakiwe kulolu cwaningo, kodwa iziguli ezine-ASA III noma IV zingase zithambekele ekucindezelekeni kokuphefumula nenhliziyo lapho zithatha i-propofol.I-33 Ngaphezu kwalokho, bonke abahlanganyeli kulolu cwaningo kwakungabesifazane abakhulelwe, futhi imiphumela ingase ihlotshaniswe nokuhlukana komzimba, ukuhlukana kwabantu besilisa.Okwesibili, sisebenzisa amaphuzu e-MOAA/S njengenkomba yezinga lokudambisa kunezinkomba eziwumgomo ezifana nokuqapha kwe-BIS.34 Okwesithathu, i-lidocaine yayisetshenziswa njenge-bolus eyodwa futhi asizange silinganise amazinga e-plasma ye-lidocaine.Okokugcina, i-ED95 inqunywa i-ED50, ngakho ucwaningo olwengeziwe luyadingeka ukuze kutholwe idatha enembe kakhudlwana.
Imiphumela yocwaningo lwethu lwamanje ibonise ukuthi ukuphathwa nge-intravenous kwe-1.0 mg/kg i-lidocaine ngaphambi komjovo we-propofol kunciphise kakhulu i-ED50, ED95, kanye nenani eliphelele le-propofol ezigulini ezithola i-hysteroscopy ye-ambulatory ye-first trimester ngaphansi kwe-anesthesia, okulingana nomthamo osebenzayo we-1.5 mg / kg.Sibheka umthamo we-1.0 mg/kg njengomthamo ofanele.Ngokumangalisayo, umthamo we-intravenous we-0.5 mg/kg i-lidocaine wandisa i-ED50 ye-propofol, okubonisa umphumela oyinkimbinkimbi we-lidocaine.Ukucwaninga okwengeziwe kwezinqubo eziyisisekelo kuyadingeka ukuze kuqinisekiswe imiphumela yethu.
Idatha etholwe ngesikhathi socwaningo ingatholakala kumlobi ohambisanayo (uNi Huang).
Ngithanda ukubonga uDkt. Huang Han womnyango wethu kanye nabahlengikazi egunjini lokuhlinza ngokungeseka kwabo okuqinile.
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