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UZhang Jingwen, i-1 Kong Lingling, i-2 Juan11ISebe le-Anesthesiology, iSibhedlele seSibini sase-China, iYunivesithi yaseSichuan, iLabhoratri ePhambili yeZiphene eziKhuselweyo kunye neZifo eziNxulumeneyo, iSebe lezeMfundo, iYunivesithi yaseSichuan, i-Chengdu, iPhondo laseSichuan, iSebe le-2 leSebe lokubelekisa kunye ne-Gynecology, i-West China yesiBini ISibhedlele seYunivesithi yaseSichuan, iziphene zokuzalwa, iLabhoratri ePhambili yeYunivesithi yaseSichuan yeMfundo kunye neZifo eziNxulumeneyo zoMphathiswa wezeMfundo, i-Chengdu, iPhondo laseSichuan Umbhali ohambelanayo: uNi Huang, iSebe le-Anesthesiology, iSibhedlele seSibini sase-China seYunivesithi yaseSichuan, iLabhoratri ePhambili yeZiphene zokuCongenital kunye neZifo zikaMama noMntwana zoMphathiswa weMfundo weYunivesithi yaseSichuan, eMzantsi San Renmin Road, Chengdu, kwiPhondo laseSichuan Duan 20, 610041 China, Tel +86 18180609890, Fax +86 28855503752, I-imeyile [i-imeyile ekhuselweyo] yayiyilwe Injongo: Esi sifundo ukuvavanya idosi esebenzayo (ED50) kunye ne-95% yeedosi ezisebenzayo ze-lidocaine ye-intravenous elawulwa kwiidosi ezahlukeneyo(ED95), umphumo wedosi yokungeniswa kwepropofol, kunye nokumisela idosi efanelekileyo.Iqela: i-saline (L0), i-lidocaine 0.5 mg / kg (L0.5), i-lidocaine 1.0 mg / kg (L1.0) kunye ne-lidocaine 1.5 mg / kg (L1.5).Yenza i-anesthesia nge-1.0 µg/kg fentanyl.I-lidocaine elungisiweyo okanye i-saline ilawulwa kamva njengoko iyalelwe, ilandelwa yipropofol.Idosi yepropofol kwisigulane ngasinye yamiselwa kusetyenziswa uyilo lophononongo olulandelelanayo olusuka phezulu ukuya phantsi.Iziphelo eziphambili ziyi-ED50 kunye ne-ED95 ye-propofol induction dose. I-total propofol doses, ixesha lokuvuka, kunye neziganeko ezimbi zabhalwa.Iziphumo: I-ED50 (i-95% yexesha lokuzithemba) yepropofol yayiphantsi kakhulu kumaqela e-L1.0 kunye ne-L1.5 kuneqela le-L0 (1.6 [1.5-1.7] mg / kg kunye ne-1.8 [1.6-1.9] mg / kg, ngokuchasene ne-2.4 [2.3-2.5] mg / kg, ngokulandelanayo; p1.0 kunye ne-L1.5 (p> 0.05) Nangona kunjalo, ngokumangalisayo, i-ED50 yayiphezulu kakhulu kwiqela le-L0 .5 kune-L0 (2.8 [2.6-3.0] mg / kg vs 2.4 [2.3-2.5] mg / kg; i-p1.0 kunye ne-L1.5 yayingaphantsi kunamaqela e-L0 kunye ne-L0.5 (p0.5 yayinkulu kune ukuba kwiqela le-L0 (i-p0.5 yayinkulu kunokuba kumaqela e-L0 kunye ne-L1.0 (pIsiphelo: Kwizigulane eziye zafumana i-first-trimester uterine aspiration, i-lidocaine ye-intravenous 1.0 mg / kg ngaphambi kwe-propofol injection yanciphisa kakhulu i-ED50 ye-propofol induction dose ngaphandle kwemiphumo emibi kakhulu, elingana nomphumo we-1.5 mg / kg umthamo.Sincoma i-1.0 mg / kg njengeyona dose efanelekileyo.Amagama angundoqo: i-lidocaine, i-propofol, i-uterine aspiration, i-dose esebenzayo ye-median Iidosi ezipheleleyo zepropofol, ixesha lokuvuka, kunye neziganeko ezimbi zabhalwa.Iziphumo: I-ED50 (i-95% yexesha lokuzithemba) yepropofol yayiphantsi kakhulu kumaqela e-L1.0 kunye ne-L1.5 kuneqela le-L0 (1.6 [1.5-1.7] mg / kg kunye ne-1.8 [1.6-1.9] mg / kg, ngokubhekiselele kwi-2.4 [2.3–2.5] mg/kg, ngokulandelanayo, p1.0 kunye 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 .0 kunye ne-L1.5 yayingaphantsi kunamaqela e-L0 kunye ne-L0.5 (i-p0.5 yayinkulu kuneqela le-L0 (i-p0.5 yayinkulu kunokuba kumaqela e-L0 kunye ne-L1.0 (pIsiphelo: Kwizigulane eziye zahamba I-first-trimester uterine aspiration, i-lidocaine ye-intravenous 1.0 mg / kg ngaphambi kwe-propofol injection yanciphisa kakhulu i-ED50 ye-propofol induction dose ngaphandle kwemiphumo emibi kakhulu, elingana nomphumo we-1.5 mg / kg umthamo.Iyonke imilinganiselo yepropofol, ixesha lokuvuka, kunye neziganeko ezimbi zabhalwa.Iziphumo: I-ED50 (i-95% yexesha lokuzithemba) yepropofol yayiphantsi kakhulu kumaqela e-L1.0 kunye ne-L1.5 kuneqela le-L0 (1.6 [1.5-1, 7] mg / ml).кг kunye 1,8 [1,6–1,9] мг/кг по сравнению с 2,4 [2,3–2,5] мг/кг соответственно, p1,0 kunye neL1,5 (p>0,05) ), однако, как ни удивительно, ED50 была значительно выше в группе L0. kg kunye ne-1.8 [1.6-1.9] mg / kg ngokuchasene ne-2.4 [2.3-2.5] mg / kg, ngokulandelanayo, i-p1.0 kunye ne-L1.5 (p> 0.05), nangona kunjalo, ngokumangalisayo, i-ED50 yayiphezulu kakhulu kwiqela le-L0 .I-0.5 kune-L0 (2.8 [2.6-3.0] mg / kg vs. 2.4 [2.3-2.5] mg / kg; i-p1.0 kunye ne-L1.5 yayiphantsi kunamaqela e-L0 kunye ne-L0.5 (p0.5 inkulu kunamaqela I-L0 kunye ne-L0.5) kwiqela le-L0 (i-p0.5 yayinkulu kunamaqela e-L0 kunye ne-L1.0 (pIsiphelo: kwizigulane ezifumana i-aspiration uterus kwi-trimester yokuqala, ukulawulwa kwe-intravenous ye-lidocaine kwi-dose ye-1.0 mg / kg ngaphambili i-injection ye-propofol yanciphisa kakhulu i-ED50 ye-dose ye-induction ye-propofol)) ngaphandle kwemiphumo emibi kakhulu, elingana nomphumo we-dose ye-1.5 mg / kg.Sincoma i-1.0 mg / kg njengeyona dose efanelekileyo.Amagama angundoqo: i-lidocaine, i-propofol , umnqweno wesibeleko, uthetha umthamo osebenzayoIyonke idosi yepropofol, ixesha lokuvuka, kunye neziganeko ezimbi zabhalwa.Ixabiso leemveliso:L1.0 kunye neL1.5 组异丙酚的ED50（95% 置信区间）显着低L0 组（1.6 [1.5–1.7]mg/9mg/1 kg,6mg/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]–6. 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吸术的患者中，丙泊酚注射前静脉注射利多卡因1.0 mg/kg 显着降低了丙泊酚诱导剂量的ED50）无严重副作用，相当于1.5 mg/kg剂量的效果。我們推荐1.0 mg/kg作為最佳剂量。关键說：利多卡因、丙泊酚、子宫抽吸、中位有效剂量。结果: 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 neL1.5 : 在 接受 妊土 早患者 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 注射利多卡因 1.0 mg/kg 显着 了 丙泊 酚 的 的 ed50） 严重 副作用 相当于 相当于 1.5 mg/kg 剂量的效果。我們推荐1.0 mg / kgIziphumo: I-ED50 (i-95% yexesha lokuzithemba) ye-propofol kwi-L1.0 kunye namaqela e-L1.5 yayiphantsi kakhulu kuneqela le-L0 (1.6 [1.5-1.7] mg / kg kunye ne-1.8 [1, 6-1.9] mg /ikg).кг соответственно 2,4 [2,3–2,5] мг/кг, p1,0 kunye L1,5 (p>0,05) в группе L0 (2,8 [2,6–2,6–2,6]). kg, ngokulandelanayo, 2.4 [2.3-2.5] mg / kg, p1.0 kunye ne-L1.5 (p> 0.05).Nangona kunjalo, ngokumangalisayo, i-ED50 yayiphezulu kakhulu kwiqela le-L0.5 kuneqela le-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 kunye ne-L1.5 yayingaphantsi kunamaqela e-L0 kunye ne-L0.5 (p0.5 inkulu kunamaqela e-L0 (p0.5 inkulu kune-L0 kunye ne-L1. Amaqela e-0 (p Izigqibo). : Kwizigulane zabasetyhini, kwizigulane Ukufumana i-trimester yokuqala ye-uterine aspiration, i-lidocaine ye-intravenous 1.0 mg / kg ngaphambi kwe-propofol injection yanciphisa kakhulu i-ED50 ye-propofol induction dose ngaphandle kwemiphumo emibi kakhulu, elingana ne-1.5 mg / kg dose Sincoma i-1.0 mg / kg kg njenge-dose efanelekileyo Amagama angundoqo: i-lidocaine, i-propofol, i-uterine aspiration, ithetha idosi esebenzayo
Ngenxa yokuba i-propofol inobomi obufutshane obufutshane kakhulu kunamanye amachiza, ipropofol idla ngokusetyenziswa njengeyeza lokuthomalalisa emithanjeni ukunika ukuthomalalisa ngexesha lotyando lwezigulana ezingaphandle.I-1,2 Nangona kunjalo, i-sedation kunye nemilinganiselo ephezulu kuphela yepropofol ihambelana nemiphumo yokuphefumula kunye ne-circulatory side effects.Amanani aphezulu epropofol anyusa umngcipheko we-apnea, ukuwa kwe-airway ephezulu, kunye ne-hypotension;I-3-7 ngelixa i-dose ephantsi ibangela ukungonelanga kwe-sedation.I-Propofol ngokudibanisa nezinye iziyobisi kunciphisa umngcipheko weengxaki zokuphefumula kunye nokujikeleza kwegazi kwaye inika umphumo okhuselekileyo nowanelisayo wokuthoba.Ngoko ke, kukho imfuneko ye-adjuvant esebenzayo yokunciphisa impendulo yokuhlinzwa kunye nokunciphisa imfuno yepropofol.Kwiminyaka yakutshanje, zombini i-midazolam kunye ne-dexmedetomidine isetyenziswe kwi-operation ye-outpatient, kodwa i-half-life ye-midazolam ide, ukufakwa kwe-dexmedetomidine kucotha, kwaye ichiza likhulu, ngoko ke ukusetyenziswa kulinganiselwe.8.9
I-Lidocaine yi-anesthetic yendawo esetyenziswa ngokubanzi kwiklinikhi. Izifundo ze-10 zangaphambili zifumene ukuba i-lidocaine ye-intravenous inokuphucula umphumo we-anesthesia esekelwe kwi-propofol. ukukhawuleza ukubuyiswa komsebenzi wesisu emva kokuhlinzwa, kunye nokunciphisa iziganeko zentlungu engapheliyo emva kokuhlinzwa.16-19 I-lidocaine ye-Intravenous inesiqingatha sobomi obufutshane (i-90-120 min), kwaye ugxininiso lwegazi oluchazwe kwizifundo zeklinikhi luhlala lungaphantsi koxinzelelo lwetyhefu (> 5 μg /mL) .20,21 Foo et al inconywa kwizikhokelo zabo zokuvumelana ezisanda kupapashwa ukuba ukuba i-lidocaine ye-intravenous isetyenzisiwe, i-dose yokuqala engekho ngaphezu kwe-1.5 mg / kg ibalwa ngokusebenzisa ubunzima bomzimba obufanelekileyo besigulane yayikhuselekile.21 Uphononongo lukaLili et al sele ibonakalisile ukuba ukulawulwa kwe-bolus intravenous lidocaine 1.5 mg / kg ngaphambi kokungeniswa kwe-anesthesia kubangele ukunciphisa i-36% kwi-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 пропофола.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 1,5 мг/кг перед индукцией анестезии приводит книж30 %.利多卡因是临床实践中广泛使用的局部麻醉剂。 10 先前的研究发现，静脉注射利多卡因可以增强基于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、术后胃肠功能加速恢复，术后慢性疼痛发生率降低。 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).20,21 Foo 等人在他们新发表的共识指南中建议，如果使用静脉注射利多卡因，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，在麻醉诱导前静脉推注利多卡時 1.5 mg/银卡kg 3.5 mg/利多卡 因 临床 实践 中 广泛 使用 的 局部 麻醉剂。 10 先前 研究 发现 ， 静脉 注射利多卡 因 可以 增强 基于 酚 的 麻醉 镇静 作用。 11-15 静脉 的 其他 手术 期益处 期益处 期益处 期益处 期益处包括 减轻注射 疼痛 、 减少 阿片类 药物 需求 、 术后 胃肠 功能 恢复 ， 术后 慢性 疼痛 发生率 降低。 16-19 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 血液 仍 低于毒性 浓度 （(> 5 мкг /мл).20,21 foo 等 在 他们 新 发表 的 识 指南 中 建议 ， 使用 静脉 注射利多卡因 使用 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 不超过 1,5 мг/кг 是 安全。 。21 lili 的 一 研究 等 人 证明 证明 ， 在 麻醉 诱导 前 推注利多卡因 推注利多卡因 1,5 мг /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 扩张 的 反应。。 22 liu 等 还 证明 ， 静脉 注射 注射 1,5 мг/кг 利多卡 可 显着 成人 患者 检查 期间 异丙酚 诱导剂量 的 ed50 ， 而 而而 而 而 而 患者 检查 异丙酚 诱导剂量的 的 , , 不会显着影响血区兒和
Ke ngoko, olu phononongo lujolise ekuvavanyeni isiphumo seedosi ezahlukeneyo ze-lidocaine ye-intravenous kwi-ED50 kunye ne-ED95 ye-propofol-inducing doses ngexesha le-trimester yokuqala ye-uterine aspiration, kunye nokugqiba idosi elona lifanelekileyo, ekuthi, ngolwazi lwethu, ayizange ifundwe. kwizifundo ezidlulileyo..
Emva kokugqiba uyilo lolingo lwezonyango, siye salutsiba uphononongo lweenqobo ezisesikweni lwangaphambili lweSibhedlele seSibini sase-West China, kwaye esilandelayo siseziinyanga ezimbalwa ukusuka.Ngoko ke, siye safuna ukuphononongwa kokuziphatha kwiKomidi yoBhaliso loBhaliso lweClinikhi yaseChina, ikomiti yokuziphatha yeziko elizimeleyo eliququzelelwe yiZiko loBhaliso lweClinical Trials Registration.Le protocol yophononongo ivunyiwe yiKomiti yezokuziphatha yeRegistry yaseTshayina yoLingo lweKlinikhi (ChiECCRCT20210401) kwaye ibhaliswe kwiRegistry yaseTshayina yovavanyo lweKlinikhi (ChiCTR2100049263).Uphononongo luqhutywe ngokuhambelana neSibhengezo saseHelsinki ukususela ngoSeptemba 2021 ukuya kuMeyi 2022, kwaye safumana imvume ebhaliweyo ebhaliweyo evela kubathathi-nxaxheba be-100 ngaphambi kokuqala kophando.
Olu phononongo lulindelekileyo lwenziwe kwizigulana ezibhinqileyo ezicwangciselwe ukwenza i-hysteroscopy ye-trimester yokuqala yesigulana sangaphandle phantsi kwe-anesthesia jikelele kwiYunivesithi yaseSichuan eSibhedlele seSibini saseTshayina.Uphononongo lwalubandakanya izigulane ezine-ASA yesimo somzimba I okanye i-II, iminyaka eyi-18-50 iminyaka kunye nokuzila ukutya kwiiyure ze-6 (i-solids) kunye neeyure ze-2 (i-liquids) ngaphambi kokuhlinzwa. Iikhrayitheriya zokukhutshwa zimi ngolu hlobo lulandelayo: izigulane ezinobunzima bomzimba (BMI)> 28 kg / m2 okanye i-BMI <18 kg / m2; Iikhrayitheriya zokukhutshwa zimi ngolu hlobo lulandelayo: izigulane ezinobunzima bomzimba (BMI)> 28 kg / m2 okanye i-BMI <18 kg / m2; Критерии исключения были следующими: пациенты с индексом массы тела (ИМТ) >28 кг/м2 или ИМТ <18 кг/м2; Iikhrayitheriya zokukhutshwa zimi ngolu hlobo lulandelayo: izigulane ezinobunzima bomzimba (BMI)> 28 kg / m2 okanye 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; Iinqobo zokukhutshwa: izigulane ezine-index mass body (BMI)> 28 kg / m2 okanye i-BMI <18 kg / m2; izigulane ezinobunzima bomzimba <40 kg; izigulane ezinobunzima bomzimba <40 kg; пациенты с массой тела <40 кг; izigulane ezinobunzima be-<40 kg;体重<40公斤的患者；体重<40公斤的患者； Пациенты с массой тела < 40 кг; Izigulane ezinobunzima be-40 kg;Izigulane ezinokuhanjiswa kwesisu kunye nembali yokuhlanjululwa komlomo wesibeleko kwiinyanga ze-6;izigulane ezichasene ne-anesthetics yendawo, i-propofol, i-fentanyl, okanye ezinye iziyobisi ezinxulumene nesi sifundo;izigulane ezinobunzima obukhulu be-hepatic kunye ne-renal, izifo ze-endocrine, izigulana ezinokuphazamiseka kwemetabolism, izifo zentliziyo, izifo zenkqubo yokuphefumla okanye izifo zenkqubo ye-nervous ye-nervous Ukusetyenziswa kwexesha elide le-sedative, i-analgesics, iziyobisi ezinokuchaphazela i-metabolism ye-anesthetics yendawo okanye izigulane ngexesha leentsuku ze-7 Zamkelwe ezinye iimvavanyo phakathi kweenyanga ze-3 phambi kophononongo Amachiza okanye izigulane ezithathe inxaxheba kwezinye iimvavanyo zeklinikhi;izigulane ezingamakhoboka otywala okanye iziyobisi zokuzonwabisa;izigulane ezinamanqaku e-Mallampati III-IV.Bonke abathathi-nxaxheba baxelelwa malunga nenjongo yophando.
Ngamafutshane, izigulane ze-100 zahlelwa ngamaqela e-L0, L0.5, L1.0, kunye ne-L1.5 ngokulandelelana okungahleliwe kwekhompyutheni kunye nobukhulu bebhloko ye-4. Inombolo ekhethekileyo ivalwe kwimvulophu ye-opaque.Iingcali ze-Anesthesiologists ezilungiselela kwaye zisebenzise amachiza ziyayazi imisebenzi yeqela.Abaphandi, izigulane, oogqirha botyando, kunye nabongikazi abaqokelele idatha babengaboni.
Awekho amanye amayeza asetyenziswayo ngaphambi kokufakwa kwe-anesthesia.I-22 gauge cannula yafakwa emthanjeni kwaza kwaqaliswa ukufakwa kwe-lactate ye-Ringer's (2 ml/kg/h).Ekungeneni kwigumbi lokusebenza, isigulane sanikwa inhalation ye-oksijini ngemaski ngesantya se-10 L / min kwimizuzu ye-3 ngaphambi kokungeniswa, kunye noxinzelelo lwegazi olungenayo, i-electrocardiogram, izinga lokuphefumula, kunye ne-peripheral capillary oxygen saturation (SpO2) ihlolwe. de isigulane sikhululwe.ukusuka kwi-anesthesia.kwaye idluliselwe kwixesha le-postoperative kwisebe le-anesthesia.I-SpO2, izinga lentliziyo (HR) kunye noxinzelelo lwegazi olungenayo lubhalwe kula manqaku amathathu alandelayo: ngexesha lokulungiselela ukufakwa kwe-anesthesia (T0), ekupheleni kokungeniswa kwe-anesthesia (T1), ekupheleni kokukhutshwa komlomo wesibeleko. (T2).Onke amalungiselelo ayenziwe kwiqondo lobushushu begumbi.ubushushu, igcinwe kwaye isetyenziswe ngoko nangoko.I-Lidocaine (iSinopharm Rongsheng Pharmaceutical Co., Ltd.) 0.5 mg / kg, 1.0 mg / kg kunye ne-1.5 mg / kg yahlanjululwa kwi-10 ml nge-saline kwi-syringe ye-10 ml.Kwakhona lungiselela umthamo olinganayo we-saline kwisirinji ye-10 ml.Intshayelelo ye-anesthesia yaqalwa ngenaliti enye ye-bolus ye-fentanyl 1.0 μg/kg (Yichang Renfu Pharmaceutical Co., Ltd., China).Ngomzuzu kamva, i-lidocaine elungiselelwe okanye i-saline ilawulwa njengoko imiselwe malunga nemizuzwana ye-30, kwaye ke ipropofol (i-Corden Pharma SPA, e-Italy) ilawulwa kuzo zonke izigulane kwizinga le-0.4 ml / s.Isigulane sokuqala kwiqela ngalinye safumana ipropofol 2.0 mg / kg.Kwizigulane ezilandelayo, i-propofol dose yanda okanye iyancipha nge-0.2 mg / kg, kuxhomekeke kwimpendulo yesigulane sangaphambili.ULumkiso oluLungisiweyo loMkhangeli/Isikali sokuRhweba (MOAA/S) sisetyenziselwe ukuvavanya ubunzulu bokuthomalalisa.I-24 Isikali se-MOAA/S sisikali se-6 kwaye sichazwa njenge-5: igama elilula ukulibiza kwithoni eqhelekileyo;4: ukusabela kokulala kwigama elibizwa ngethoni eqhelekileyo;3: kuphela ngelizwi elikhulu kunye/okanye eliphindaphindayo emva kokubiza igama;2: impendulo kuphela ekuvuseleleni kancinci okanye ukungcangcazela;I-1: impendulo kuphela kwi-contraction ebuhlungu ye-trapezius muscle;0: akukho mpendulo kwi-trapezius muscle contraction. Emva kokuba inqaku le-MOAA / S libe <1, ugqirha wavunyelwa ukuba aqalise ukubeka i-speculum ye-vaginal, ebonisa ukuqala komsebenzi. Emva kokuba inqaku le-MOAA / S libe <1, ugqirha wavunyelwa ukuba aqalise ukubeka i-speculum ye-vaginal, ebonisa ukuqala komsebenzi. После того, как оценка MOAA/S была <1, хирургу было разрешено начать установку вагинального зеркала, что сигнализировало о началение. Emva kokuba inqaku le-MOAA / S libe <1, ugqirha wavunyelwa ukuba aqalise ukufaka i-speculum ye-vaginal, ebonisa ukuqala kokusebenza.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.在 MOAA/S После того, как оценка MOAA/S <1, хирургу было разрешено начать установку вагинального зеркала, что ознаменовало начало процедур. Emva kokuba amanqaku e-MOAA/S abe <1, ugqirha wavunyelwa ukuba aqalise ukufaka i-speculum ye-vaginal, ephawula ukuqala kwenkqubo.Lonke utyando lwenziwa ngugqirha omnye.Isiphumo sasithathwa njengento engafanelekanga ukuba i-MOAA/S yayiyi-≥1 emva kwe-dose yokuqala ye-propofol okanye ukuba ukunyakaza kwamalungu kwabonwa ukususela ekuqaleni ukuya ku-dilatation yomlomo wesibeleko;kungenjalo, isiphumo sagqalwa njengento ebalulekileyo.Kwiimeko ezingasebenziyo, umthamo wepropofol wanda ngo-0.2 mg / kg kwizigulane ezilandelayo.Ipropofol yancitshiswa ngu-0.2 mg / kg kwizigulane ezilandelayo kwiimeko ezisebenzayo.Ukuba i-MOAA / S i-≥1 okanye ukunyakaza kwamalungu kubonwa ngexesha lotyando, i-propofol 0.5-1.0 mg / kg inikezelwa ngokwemfuno yeklinikhi.Emva kokungeniswa kwe-anesthesia, ukuba ixesha le-apnea lidlula i-1 min, kwachazwa njengokudakumba kokuphefumula kunye nokuphefumula komatshini kwenziwa kwaze kwaba yilapho ukuphefumula ngokuzenzekelayo kubuyiselwe.Ukuba umqobo womoya ophezulu uqatshelwe, phakamisa umhlathi ongezantsi ukuvumela umoya. Ukuba i-SpO2 <92%, i-hypoxia yachazwa kwaye inkqubo yamiswa, kwaye i-mask ye-mask encediswayo isetyenziselwa ukuhlalisa umoya we-oxygen. Ukuba i-SpO2 <92%, i-hypoxia yachazwa kwaye inkqubo yamiswa, kwaye i-mask ye-mask encediswayo isetyenziselwa ukuhlalisa umoya we-oxygen. При SpO2 <92% определяли гипоксию и процедуру прекращали, а для нормализации сатурации кислородом применяли вспомогательюсья вспомогательюнуки Kwi-SpO2 <92%, i-hypoxia yamiselwa kwaye inkqubo yanqunyanyiswa, kwaye i-facial mask ye-ventilation encedisayo yayisetyenziselwa ukulungelelanisa i-oxygen saturation.如果SpO2 < 92%，则定里為缺氧并停止手术，并应用辅助面罩通气以使氧饱和度正常化。如果SpO2 < 92%，则定里為缺氧并停止手术，并应用辅助面罩通气以使氧饱和度正常化。 Если SpO2 < 92%, определите гипоксию и прекратите операцию, а также примените искусственную вентиляцию легких сномощьюки маские для оправда. Ukuba i-SpO2 <92%, misela i-hypoxia kwaye uphelise utyando, kwaye ukhuphe umoya nge-mask ukulungelelanisa ukugcwala kwe-oksijini. Ukuba i-HR yayingu-<50 beats / min, i-atropine 0.5 mg ilawulwa. Ukuba i-HR yayingu-<50 beats / min, i-atropine 0.5 mg ilawulwa. Если ЧСС <50 уд/мин, вводили атропин 0,5 мг. Ukuba izinga lentliziyo <50 bpm, i-atropine 0.5 mg ilawulwa.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. Ukuba izinga lentliziyo <50 bpm, nika i-0.5 mg atropine. I-Hypotension yachazwa njenge-SBP, i-diastolic blood pressure (DBP), okanye i-arterial pressure (MAP) iyancipha ngaphezu kwe-20% yesiseko, okanye i-SBP <80 mmHg. I-Hypotension yachazwa njenge-SBP, i-diastolic blood pressure (DBP), okanye i-arterial pressure (MAP) iyancipha ngaphezu kwe-20% yesiseko, okanye i-SBP <80 mmHg. Гипотензия определялась как снижение САД, диастолического артериального давления (ДАД) или среднего артериального давления (САД) больше САД! I-Hypotension yachazwa njengokuncipha kwe-SBP, i-diastolic blood pressure (DBP), okanye i-arterial pressure (MAP) ngaphezu kwe-20% yesiseko, okanye i-SBP <80 mmHg.或平均动脉压(MAP) 下降超过基线的20%，或SBP<80 mmHg. 20%, 或SBP <80 mmHg. Гипотензию определяли как снижение более чем на 20% от исходного уровня САД, диастолического артериального давлеения (ДАД) или сартериального давления (ДАД) или спасение. I-Hypotension ichazwe njengokunciphisa ngaphezu kwe-20% ukusuka kwisiseko kwi-SBP, i-diastolic blood pressure (DBP), okanye i-arterial pressure (MAP), okanye i-SBP <80 mmHg.Ukuba i-hypotension iyenzeka, i-0.2-0.4 mg ye-metahydroxylamine okanye i-5-10 mg ye-ephedrine ilawulwa, kuxhomekeke kwimeko.Idosi yepropofol iyonke, ixesha lokusebenza, kunye nexesha lokubuyisela ekupheleni komsebenzi lirekhodwe.I-Myoclonus kunye nemiphumo emibi ye-anesthetics yendawo nayo iye yaxelwa, njenge-tinnitus, i-perioral numbness, kunye ne-palpitations elandela i-propofol.
Iziphelo eziphambili ziyi-ED50 kunye ne-ED95 ye-propofol induction dose.Isiphelo sesibini sasiyi-dose ye-propofol epheleleyo, ixesha lokubuyisela emva kokusebenza, ukudakumba kokuphefumula, ukuvinjelwa komoya ophezulu, i-hypoxia, i-bradycardia, i-hypotension, kunye ne-postpropofol myoclonus.
Ukuzimela kunye nokusasazwa okungaziwayo kwedatha efundwe ngendlela elandelelanayo ephezulu-phantsi yenza kube nzima ukuqulunqa imigaqo engqongqo yethiyori yokubala ubungakanani besampulu.25 Ubungakanani besampulu bunqunywe ngumgaqo wokumisa.Izigulane kufuneka zibhaliswe phambi kokuba ubuncinane izibini ezintandathu zeziphumo ezingasebenziyo ziguqulelwe kwiziphumo ezisebenzayo.Izifundo zokulinganisa zibonise ukuba, kwiimeko ezininzi, ukubandakanywa ubuncinane bezigulane ze-20-40 kunokubonelela ngoqikelelo oluzinzile lwedosi ekujoliswe kuyo.Olunye ulingo lwe-anesthesia usebenzisa le ndlela lubandakanya izigulane ezingama-20-40.I-26,27 Kwisifundo sethu, iqela ngalinye libandakanya izigulane ze-25, ezaneleyo uhlalutyo lwamanani.
I-SPSS 26.0 (IBM Inc., Armonk, NY, USA) yayisetyenziselwa ukuhlalutya iziphumo.Uvavanyo lwe-Shapiro-Wilk lusetyenziswe ukumisela ukuhanjiswa okuqhelekileyo kwedatha.Izinto eziguquguqukayo ezisasazwa rhoqo zichazwe njengentsingiselo ± ukutenxa okusemgangathweni kwaye kuthelekiswe phakathi kwamaqela asebenzisa indlela enye i-ANOVA.Idatha engasasazwanga ngokuqhelekileyo yaboniswa njenge-median (uluhlu lwe-interquartile) kwaye luthelekiswa nokusetyenziswa kwe-Wilcoxon ye-rank sum test.Idatha yoluhlu inikwe njenge-n (%) kwaye ihlalutywe kusetyenziswa uvavanyo lwe-chi-square.I-ED50 (95% CI) yepropofol yabalwa njengentsingiselo ye-midpoint ye-zero ebalulekileyo ye-crossover usebenzisa i-ANOVA yendlela enye kunye nendlela ye-Bonferroni yokuthelekisa phakathi kwamaqela.I-ED95 (95% CI) yaqikelelwa kusetyenziswa ukuhlehla okunokwenzeka. Kulo lonke uhlalutyo, i-p <0.05 yayicatshangelwa ukuba ibonise ukungafani okubalulekileyo kwezibalo. Kulo lonke uhlalutyo, i-p <0.05 yayicatshangelwa ukuba ibonise ukungafani okubalulekileyo kwezibalo. Для всех анализов считалось, что p<0,05 указывает на статистически значимые различия. Kulo lonke uhlalutyo, i-p <0.05 yayicatshangelwa ukuba ibonise umahluko obalulekileyo 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 Для всех анализов считалось, что p<0,05 указывает на статистически значимое различие. Kulo lonke uhlalutyo, i-p <0.05 yayicatshangelwa ukuba ibonise umahluko obalulekileyo ngokwezibalo.
Ziyi-121 zizonke izigulane ezabhaliswayo zaza zavavanywa.Kwezi, izigulane ze-100 zifakwe ngokungahleliwe zibe ngamaqela e-4 kwaye zifakwe kuhlalutyo lokugqibela (Umfanekiso 1).Iimpawu ezisisiseko zamaqela amane ezigulane, kubandakanywa ubudala, i-BMI, izinga lentliziyo (T0), i-SBP (T0), i-DBP (T0) kunye ne-SBP (T0), ayizange ihluke kakhulu (iThebhile 1).
Ulandelelwano oluphezulu olubonisa umthamo kunye nempendulo yesigulane iboniswe ngezantsi (Umfanekiso 2).Imilinganiselo ye-propofol infusion doses kwi-L0, L0.5, L1.0, kunye namaqela e-L1.5 yayiyi-2.3±0.2, 2.7±0.3, 1.6±0.2, kunye ne-1.7±0.2 mg / kg, ngokulandelanayo.Kwikhiwane.I-3 ibonisa uhlalutyo lwempendulo yedosi ye-lidocaine kunye nepropofol kumaqela amane ezigulane.Itheyibhile ye-2 ibonisa i-ED50 kunye ne-ED95 (i-95% CI) ye-propofol yeengalo ezine, ngokusekelwe kwi-Dixon-Massey i-ordinal up-down order kunye nokunciphisa amathuba, ngokulandelanayo. I-ED50 yepropofol kumaqela e-L1.0 kunye ne-L1.5 yayingaphantsi kakhulu kwelo kwiqela 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 yepropofol kumaqela e-L1.0 kunye ne-L1.5 yayingaphantsi kakhulu kwelo kwiqela 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 yepropofol kumaqela e-L1.0 kunye ne-L1.5 yayiphantsi kakhulu kuneqela le-L0 (1.6 [1.5-1.7] mg / kg; 1.8 [1.6-1.9] mg / kg).kg ngokuchasene ne-2.4 [2.3-2.5] mg / kg).кг кг, р<0,001). kg 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 [2.3–2.5kg公] mg/ p <0.001 L0, p <0.001).Ipropofol ED50 yayiphantsi kakhulu kwiqela le-L1.0 kunye ne-L1.5 kuneqela le-L0 (1.6 [1.5-1.7] mg / kg; 1.8 [1.6-1.9] mg / kg).kg ngokuchasene ne-2.4 [2.3-2.5] mg / kg)./кг кг, p <0,001). /kg kg, p <0.001). Ixabiso le-ED50 laliphezulu kwiqela le-L0.5 kuneqela le-L0 (2.8 [2.6-3.0] mg / kg vs 2.4 [2.3-2.5] mg / kg, p<0.05). Ixabiso le-ED50 laliphezulu kwiqela le-L0.5 kuneqela le-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 kwiqela le-L0.5 kuneqela 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）. 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). Iqela le-L0.5 linexabiso eliphezulu le-ED50 kuneqela le-L0 (2.8 [2.6-3.0] mg / kg vs. 2.4 [2.3-2.5] mg / kg, p<0, 05). Kwakungekho mmahluko obalulekileyo kwi-ED50 yepropofol phakathi kwamaqela e-L1.0 kunye ne-L1.5 (p> 0.05). Kwakungekho mmahluko obalulekileyo kwi-ED50 yepropofol phakathi kwamaqela e-L1.0 kunye ne-L1.5 (p> 0.05). Не было существенной разницы в ED50 пропофола между группами L1.0 kunye L1.5 (p>0,05). Kwakungekho mmahluko obalulekileyo kwi-propofol ED50 phakathi kwe-L1.0 kunye ne-L1.5 amaqela (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 kunye ne-группой L1.5 (p>0,05). Kwakungekho mmahluko obalulekileyo kwi-propofol ED50 phakathi kweqela le-L1.0 kunye neqela le-L1.5 (p> 0.05).
Itheyibhile ye-2 ED50 kunye ne-ED95 (95% CI) yamaqela amane epropofol esekelwe kumyalelo ophezulu kunye nophantsi kwe-Dixon-Massey yokusabalalisa kunye ne-Probit regression
Umzobo 2 Dixon phezulu nasezantsi amaqela amane.“●” lithetha ukuba semthethweni, “○” lithetha into engekhoyo.
Kwakungekho nantlukwano ebalulekileyo phakathi kwamaqela kwixesha lotyando kunye nexesha lokuvuka njengoko kudweliswe kwiThebhile 3 (p> 0.05). Kwakungekho nantlukwano ebalulekileyo phakathi kwamaqela kwixesha lotyando kunye nexesha lokuvuka njengoko kudweliswe kwiThebhile 3 (p> 0.05). Не было никаких существенных различий между группами в продолжительности операции и времени пробуждения, как указано, 3блиц>0. Kwakungekho nantlukwano ebalulekileyo phakathi kwamaqela ngexesha lokusebenza kunye nexesha lokuvuka, njengoko kuboniswe kwitheyibhile 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. Akukho mahluko ubalulekileyo kwixesha lomsebenzi kunye nexesha lokuvuka phakathi kwamaqela (p>0.05), njengoko kubonisiwe kwiThebhile yesi-3. Imilinganiselo ye-propofol epheleleyo efunekayo yokuhlinzwa yonke yayinkulu kakhulu kumaqela e-L0 kunye ne-L0.5 kunamanye amaqela amabini (p <0.05, iThebhile 3). Imilinganiselo ye-propofol epheleleyo efunekayo yokuhlinzwa yonke yayinkulu kakhulu kumaqela e-L0 kunye ne-L0.5 kunamanye amaqela amabini (p <0.05, iThebhile 3). Средние дозы общего пропофола, необходимые для всей операции, были значительно выше в группах L0 kunye L0,5, чем 0, 3,5, для 0, 5, 5, 5 Imilinganiselo yemilinganiselo yepropofol efunekayo kuwo wonke umsebenzi yayiphezulu kakhulu kumaqela e-L0 kunye ne-L0.5 kunamanye amaqela amabini (p <0.05, iThebhile 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 kunye L0,5, чем 0, 3,5, для 0, 3. I-dose ye-dose ye-propofol epheleleyo efunekayo kuyo yonke inkqubo yayiphezulu kakhulu kumaqela e-L0 kunye ne-L0.5 kunamanye amaqela amabini (p <0.05, iThebhile 3). Kwakungekho mahluko ubalulekileyo phakathi kwamaqela kwisehlo sothintelo lomoya ophezulu (p> 0.05). Kwakungekho mahluko ubalulekileyo phakathi kwamaqela kwisehlo sothintelo lomoya ophezulu (p> 0.05). Существенных различий между группами по частоте возникновения обструкции верхних дыхательных путей не было (p>0,05). Kwakungekho nantlukwano ebalulekileyo phakathi kwamaqela kwiziganeko zokuphazamiseka 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). Kwakungekho mmahluko obalulekileyo kwisiganeko sokuphazamiseka kwendlela yomoya ephezulu phakathi kwamaqela (p> 0.05). Isiganeko sokudakumba kokuphefumula kwiqela le-L0.5 lalilikhulu kunokuba kumaqela L0 kunye ne-L1.0 (p <0.05). Isiganeko sokudakumba kokuphefumula kwiqela le-L0.5 lalilikhulu kunokuba kumaqela L0 kunye ne-L1.0 (p <0.05). Частота угнетения дыхания в группе L0,5 была выше, чем в группах L0 kunye L1,0 (p<0,05). Ubuninzi bokudandatheka kokuphefumula kwiqela le-L0.5 laliphezulu kunamaqela e-L0 kunye 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）。 Частота угнетения дыхания в группе L0,5 была выше, чем в группах L0 kunye L1,0 (p<0,05). Ubuninzi bokudandatheka kokuphefumula kwiqela le-L0.5 laliphezulu kunamaqela e-L0 kunye ne-L1.0 (p <0.05). Kwakungekho nantlukwano ebalulekileyo phakathi kwamaqela ekuveleni kwe-hypotension (p> 0.05), kodwa i-SBP iyancipha emva kokungeniswa kwe-anesthesia kwiqela le-L0.5 yayinkulu kuneqela le-L0 (p <0.01). Kwakungekho nantlukwano ebalulekileyo phakathi kwamaqela ekuveleni kwe-hypotension (p> 0.05), kodwa i-SBP iyancipha emva kokungeniswa kwe-anesthesia kwiqela le-L0.5 yayinkulu kuneqela le-L0 (p <0.01). Достоверных различий между группами по частоте гипотензии не было (p>0,05), но снижение САД после индукции анестезип 1,пшезип 5, пушение 1. Kwakungekho nantlukwano ebalulekileyo phakathi kwamaqela kwiimeko ze-hypotension (p> 0.05), kodwa ukuhla kwe-SBP emva kokungeniswa kwe-anesthesia kwakukhulu kwiqela le-L0.5 kuneqela 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下度0険廄（大SBP丅度0険廄。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丅度0険廄）大SBP丅度0険组） Не было существенной разницы в частоте гипотензии между двумя группами (p>0,05), но снижение САД после индукции плуппами. Kwakungekho nantlukwano ebalulekileyo kwisiganeko se-hypotension phakathi kwamaqela amabini (p> 0.05), kodwa ukunciphisa i-SBP emva kokungeniswa kwe-anesthesia kwakukhulu kwiqela le-L0.5 kuneqela le-L0 (p <0.01).Akukho namnye kwizigulane ezakha i-bradycardia kunye ne-hypoxia.Akukho sigulana sichaze isicaphucaphu, i-tinnitus, ukuba ndindisholo kweperioral, kunye nokubetha ngamandla.Isigulane #20 kwiqela le-L1.0 liphuhlise i-myoclonus yobuso emva kwe-dose yokuqala ye-propofol 1.8 mg / kg, kunye nesigulane #10 kwiqela le-L1.5 liphuhlise i-myoclonus yobuso kunye neziphelo emva kwedosi yokuqala ye-propofol 1.4 mg / kg..I-Myoclonus iyayeka emva kwemizuzwana ye-30-60. Kwakungekho nantlukwano ebalulekileyo phakathi kwamaqela kwiziganeko ze-myoclonus (p> 0.05). Kwakungekho nantlukwano ebalulekileyo phakathi kwamaqela kwiziganeko ze-myoclonus (p> 0.05). Достоверных различий между группами по частоте миоклонуса не было (p>0,05). Kwakungekho nantlukwano ebalulekileyo phakathi kwamaqela kwiziganeko 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 mmahluko obalulekileyo kwi-frequency ye-myoclonus phakathi kwamaqela (p> 0.05).
Kulwazi lwethu, olu luphononongo lokuqala olulindelekileyo olubonisa isiphumo seedosi ezahlukeneyo ze-lidocaine emithanjeni kwi-ED50 kunye ne-ED95 yedosi yokungeniswa kwepropofol kwizigulana eziphantsi kwe-hysteroscopy ye-trimester yokuqala.Iziphumo zibonise ukuba ukulawulwa kwe-intravenous ye-lidocaine kwi-dose ye-1.0 mg / kg ngaphambi kokuba i-injection ye-propofol inciphise kakhulu i-ED50, i-ED95 kunye ne-dose ye-propofol epheleleyo, elingana nomphumo we-dose ye-1.5 mg / kg.Ngoko ke sincoma i-dose ephantsi ye-1.0 mg / kg njengeyona dose efanelekileyo yonyango olusebenzayo lwe-anesthesia ye-intravenous kunye nepropofol.Samangaliswa ukufumanisa ukuba ukulawulwa kwe-intravenous ye-0.5 mg / kg i-lidocaine yokwandisa i-ED50 ye-propofol, ebonisa umphumo onzima we-lidocaine.
Ngenxa yokuqalisa ngokukhawuleza kwesenzo kunye nokubuyiswa ngokukhawuleza, ipropofol isoloko isetyenziselwa ukuxilisa kwiinkqubo zokuhlinzwa ezingaphandle.Nangona kunjalo, iidosi eziphezulu zepropofol zandisa umngcipheko we-apnea, ukuwa kwe-airway ephezulu, kunye ne-hypotension, ngelixa i-dose ephantsi ibangele ukungabikho ngokwaneleyo kwe-sedation.Ngoko ke, kukho imfuneko ye-adjuvant esebenzayo yokunciphisa impendulo yokuhlinzwa kunye nokunciphisa imfuno yepropofol.Kwiminyaka yakutshanje, uphando oluninzi luye lwabonisa imiphumo ye-analgesic ye-lidocaine ye-intravenous, kuquka ukunciphisa intlungu emva kwe-propofol injection, ukunciphisa iimfuno ze-opioid, kunye nokunciphisa intlungu engapheliyo emva kokuhlinzwa.Kwiingcebiso zabo zokuvumelana ezipapashiweyo, uFoo et al.cebisa ukuba idosi yokuqala ingabi ngaphezu kwe-1.5 mg/kg ebalwa kusetyenziswa ubunzima bomzimba obufanelekileyo ikhuseleke kwi-lidocaine emithanjeni.Kutshanje, uLiu et al.kunye noYu et al.wabonisa ukuba ukulawulwa kwe-lidocaine nge-intravenous ngaphambi kokungeniswa kwe-anesthesia kubangele ukuncipha kwe-ED50 ye-propofol kwi-gastroscopy kunye nezigulane ze-hysteroscopy.Ke, isifundo sethu sijolise ekuvavanyeni isiphumo seedosi ezahlukeneyo ze-lidocaine ye-intravenous kwi-propofol-induced ED50 kunye ne-ED95 ngexesha le-trimester yokuqala ye-uterine aspiration kunye nokumisela idosi efanelekileyo.Asibandakanyi izigulane ezinembali yokunikezelwa kwesisu kwaye ngubani oye wahlanjululwa ngumlomo wesibeleko phakathi kweenyanga ze-6 kuba sicinga ukuba izigulane ezinembali yokuhanjiswa kwesisu okanye imbali yokukhutshwa komlomo wesibeleko yayinokuvuselela okuncinci komlomo wesibeleko ngexesha lokuhlanjululwa kokuhlinzwa kunezigulane ezingenayo imbali yokutshatyalaliswa komlomo wesibeleko.ukwanda komlomo wesibeleko wesigulane.28 Oku kunokukhokelela kwiziphumo ezichaneke ngakumbi.
I-lidocaine ye-intravenous ine-half-life yemizuzu emi-5-8 kuphela, iqala kwi-vascular bed kwaye ingena kwii-tissue ze-peripheral, kuqala kwiindawo zokukhupha okuphezulu (intliziyo, imiphunga, isibindi, i-spleen), kwaye emva koko kwiindawo ze-hypoperfusion.imisipha kunye nezicubu ze-adipose).10 Kwisifundo sethu, silawula i-lidocaine ngaphambi kokuba i-propofol induction ukugcina i-plasma concentration yayo ngaphakathi koluhlu olusebenzayo.Ngenxa yoko, ukusetyenziswa kwe-1.5 mg / kg ye-lidocaine phambi kwepropofol kubangele ukunciphisa i-26% kwi-ED50 ye-propofol, kunye ne-1.0 mg / kg i-lidocaine yabangela ukunciphisa i-30%.Ezi ziphumo ziyangqinelana nezo zikaLiu kunye noXu, zibonisa ukuba i-lidocaine kula mayeza ineempembelelo ze-analgesic kunye ne-antihyperalgesic.Okumangalisayo kukuba, nangona kunjalo, i-ED50 yonyuswa nge-lidocaine ye-intravenous kwi-0.5 mg / kg, ebonisa ukuba umphumo we-0.5 mg / kg umthamo unokuguqulwa kwaye i-dose ephantsi kakhulu ye-lidocaine ye-intravenous inokudibaniswa nokusabela okubukhali kwe-hypersensitivity ehambelana ne-nervous. ukonwaba.I-Lidocaine isebenza kwiithagethi ezininzi ze-molecular ezibandakanyekayo kwi-nociception enzima kunye nengapheliyo, kubandakanywa i-N-methyl-D-aspartate (NMDA) kunye ne-muscarinic cholinergic (m1, m3) i-receptors, amaxesha angama-100-1000 anobucayi kunezinye iinjongo.I-20,29 I-NMDA, i-m1 kunye ne-m3 i-receptors zihlala zivakalelwa kwiimpawu ze-lidocaine ezingaphantsi kweekliniki ezifanelekileyo ze-plasma.I-Lidocaine inqanda ukusebenza kwee-receptors ze-NMDA zabantu kwii-nanomolar concentrations kunye ne-inhibition ephezulu kwi-millimolar range, okubangelwa ukukhululeka kweentlungu.I-Lidocaine isebenza kwi-muscarinic cholinergic receptors kwi-concentration- kunye nexesha elixhomekeke kwindlela.Claes et al.ibonise ukuba ukulawulwa kwe-intravenous ye-lidocaine kwi-dose ye-10 kunye ne-30 mg / kg yokwandisa ukukhululwa kwe-acetylcholine ye-intraspinal kunye ne-induced analgesia ephakathi ngokuvula i-muscarinic receptors kwiigundane, kodwa i-dose ye-1 mg / kg i-lidocaine ayizange ikhulise kakhulu ukukhululwa kwe-acetylcholine ye-intraspinal.Izifundo ze-30,31 nazo zibonise ukuba i-lidocaine ivimba i-m1 kunye ne-m3 i-muscarinic receptors kwiindawo eziphantsi kakhulu ze-nanomolar (IC50 ye-18 nM ye-m1 kunye ne-370 nM ye-m3).Ukongezelela, ukubonakaliswa kwexesha elide kwi-lidocaine kwi-IC50 kubangele ukuguqulwa kwe-biphasic ye-m1 kunye ne-m3 receptors kunye nokuvinjelwa kokuqala okulandelwa kwiiyure ze-8 kamva ngokunyuka kwezibonakaliso.32 Ngaloo ndlela, i-bolus yethu enye yeedosi eziphantsi kakhulu ze-lidocaine i-0.5 mg / kg ngaphandle kokuvezwa ixesha elide inokusebenza ngokuyinhloko ngokuvinjelwa kwe-m1 kunye ne-m3 receptors.Ukuvinjelwa kwe-m1 kunye ne-m3 i-receptors yavakaliswa ngakumbi, enokuthi ichaze ukunyuka kwe-ED50 kwiqela le-L0.5 kwisifundo sethu.Nangona kunjalo, kwisifundo sethu, asizange silinganise i-plasma concentration ye-lidocaine.Uphando olongezelelweyo kunye nokuqinisekiswa kuyafuneka ukuze kuqinisekiswe le ngqikelelo.
I-dose ye-dose ye-propofol epheleleyo efunekayo kuwo wonke umsebenzi yayiphezulu kakhulu kumaqela e-L0 kunye ne-L0.5 kunamanye amaqela amabini.Ubuninzi bokudandatheka kokuphefumula kwiqela le-L0.5 laliphezulu kuneL0 kunye ne-L1.0 amaqela.Ukuncipha kwe-SBP emva kokungeniswa kwe-anesthesia kwiqela le-L0.5 lalilikhulu kuneqela le-L0.Akukho nasinye isigulana esaphuhlisa i-hypoxia, njengoko senza i-chin lift okanye i-mask ventilation ngexesha elifanelekileyo.Idosi eyandisiweyo yepropofol iyonke, ukuphindaphindeka kokudakumba kokuphefumula, kunye nokuncipha koxinzelelo lwegazi lwe-systolic emva kokungeniswa kwe-anesthesia kwiqela le-L0.5 likwacebise ukuba idosi ephezulu yepropofol inokunyusa umngcipheko wokuphefumla kunye noxinzelelo lokujikeleza.Kwakungekho nantlukwano kwizehlo zeziganeko ezimbi phakathi kwamaqela L0, L1.0 kunye ne-L1.5.Nangona kunjalo, ngokunikezelwa koyilo lwesifundo sethu, i-dose ye-propofol-inducing dose kwiqela ngalinye yayisondele kwi-ED50 kodwa ingaphantsi kwe-ED95.Ngaloo ndlela, iziganeko zeziganeko ezimbi zinokuba ziphezulu ukuba izigulane zeqela le-L0 zenziwe ngepropofol kwi-dose ye-ED95 (2.8 [2.6-3.2] mg / kg).Nangona kunjalo, umphumo we-lidocaine ubangele i-ED95 ye-2.0 (1.9-2.4) mg / kg kunye ne-2.1 (1.9-2.4) mg / kg kumaqela e-L1.0 kunye ne-L1.5, ngokulandelanayo, kwiidosi eziphantsi.Le ngxoxo ingentla ichaza ukuba kutheni sikholelwa ukuba i-analgesic effect ye-intravenous lidocaine kwimilinganiselo efanelekileyo kwaye ngexesha elifanelekileyo luncedo ekunciphiseni iingxaki ze-anesthesia ezibangelwa yi-propofol.Kwisifundo sethu, akukho ntlukwano ebalulekileyo kwi-ED50, i-dose ye-propofol iyonke, ixesha lokuvuka, kunye neziganeko ezimbi phakathi kwe-L1.0 kunye ne-L1.5 amaqela.Ngoko ke sincoma umthamo ophantsi we-1.0 mg / kg IV i-lidocaine njengeyona dose efanelekileyo.
Kukho imida kwisifundo sethu.Okokuqala, kuphela izigulane ezine-ASA I okanye i-II zifakwe kolu cwaningo, kodwa izigulane ezine-ASA III okanye i-IV zinokuthi zilungele ukuphefumla kunye nokudakumba kwentliziyo xa zithatha ipropofol.33 Ngaphezu koko, bonke abathathi-nxaxheba kolu phononongo babengabafazi abakhulelweyo, kwaye iziphumo zinokuthi zihambelane nokwahluka kwe-physiological, umahluko phakathi kwamadoda.Okwesibini, sisebenzisa amanqaku e-MOAA/S njengesalathisi senqanaba lokuthomalalisa kunezalathi zenjongo ezifana nokubeka iliso kwi-BIS.34 Okwesithathu, i-lidocaine ilawulwa njenge-bolus enye kwaye asizange silinganise amanqanaba e-plasma ye-lidocaine.Ekugqibeleni, i-ED95 igqitywe yi-ED50, ngoko uphando olongezelelweyo luyafuneka ukufumana idatha echanekileyo.
Iziphumo zophononongo lwethu lwangoku zibonise ukuba ukulawulwa kwe-intravenous ye-1.0 mg / kg ye-lidocaine ngaphambi kwe-propofol injection yanciphisa kakhulu i-ED50, i-ED95, kunye ne-dose ye-propofol epheleleyo kwizigulane ezihamba nge-first-trimester ambulatory hysteroscopy phantsi kwe-anesthesia, elingana nedosi esebenzayo ye-1.5 mg / ikg.Sithatha umthamo we-1.0 mg / kg ukuba ibe yi-dose efanelekileyo.Okumangalisa kukuba, umthamo we-intravenous we-0.5 mg / kg i-lidocaine yandisa i-ED50 ye-propofol, ebonisa umphumo onzima we-lidocaine.Uphononongo olongezelelweyo lweendlela ezisisiseko ziyafuneka ukuze kuqinisekiswe iziphumo zethu.
Idatha efunyenwe ngexesha lokufunda inokufumaneka kumbhali ohambelanayo (uNi Huang).
Ndingathanda ukubulela uDkt Huang Han ovela kwisebe lethu kunye nabongikazi kwigumbi lokusebenza ngenkxaso yabo enamandla.
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