镇静镇痛方案用于hifu治疗子宫肌瘤的初步临床-第三军医大学学报.docVIP

镇静镇痛方案用于HIFU治疗子宫肌瘤的初步临床研(究 冉隆青，魏安宁，陈文直（重庆医科大学附属第二医院，重庆400012） 摘要 目的:评价等制订的阶梯式逐步给药的镇静镇痛方案（ABCDE方案）用于高强度聚焦超声（high intensity focus ultrasound，HIFU）治疗子宫肌瘤的安全性和可行性。方法:20例ASAⅠ～Ⅱ级的子宫肌瘤患者，在采用ABCDE方案进行镇静和镇痛的条件下，用HIFU治疗子宫肌瘤。结果: 20例患者镇静深度ramsy评级平均为2.82±0.43），无例出现镇静评级大于4级，无苏醒延迟。20例患者疼痛评分平均值为3.84±0.71），评分低于4分的患者13例,镇痛有效率为65.5% (13/20)。治疗中的平均动脉压、心率、氧饱和度，与治疗前比较差别无显著性（0.05）。呼吸平均次数治疗中较治疗前下降，差别有显著性(0.05) 结论:等制定的阶梯式逐步用药的镇静镇痛方案（ABCDE方案），用于HIFU治疗子宫肌瘤是安全和可行的。 关键词HIFU；子宫肌瘤镇静镇痛 The protocol for sedation and analgesia in treatment of uterine fibroids by HIFU：a preliminary clinical study RAN Long-qing, WEI An-ning, CHEN Wen-zhi (Department of anesthesi, the second affiliated hospital, Chongqing medical university, Chongqing 400012,china) Abstract ：Objective To evaluate the safety and feasibility of stepwise protocol for sedation and analgesia (ABCDE protocol, developed by et al.) in treatment of uterine fibroids by high intensity focus ultrasound（HIFU）. Methods Twenty Patients with uterine fibroids (ASA Ⅰ－Ⅱ) were treated by HIFU after sedation and analgesia with The stepwise protocol. Results The average Ramsy sedation scores was 2.82±0.43, None of scores was more than 4 and no patient was delay for palinesthesia .The average pain score was 3.84±0.712 in 20 cases and there were 13 whose pain scores were under 4, The effective power of analgesia was 65.5% (13/20), There was no statistical significance for MPA,Spo2 and heart rate pre or during treatment (p0.05). The respiratory rate during treatment decreased compared with pre- treatment and showed statistical significance(p0.05) . Conclusion The stepwise protocol for sedation and analgesia is safe and feasible in treatment of uterine fibroids by HIFIU. Key words ：sedation ; analgesia ; HIFU ; uterine fibroids HIFU治疗子宫肌瘤的研究已经开展多年，治疗时常采用硬膜外麻醉和全身麻醉两种方式其基本能满足HIFU治疗的麻醉要求，但由于患者对治疗区疼痛无感觉， 对治疗过程中可能出现的神经损伤也不能及时发现，可导致暂时或永久性的神经损害，皮肤。因此，临床需要一种新的镇痛方式，既能让患者及时感觉到HIFU治疗时可能出现的神经刺激症状，又能耐受治疗中出现的疼痛和不适，让治疗安全而顺利地进行。本采用逐步加药的镇静镇痛方案（ABCDE方案由等［1］制定用于HIFU治疗