氯胺酮复合丙泊酚用于人工流产术150例观察

A Clinical Observation of Ketamine and Propofol in Artificial Abortion

目的:观察小剂量氯胺酮复合丙泊酚用于无痛人流术中丙泊酚的用量和并发症发生情况。方法:将自愿接受无痛人工流产术的患者300例,随机分为氯胺酮组(K组)和芬太尼组(F组),每组150例,两组均开放上肢手背静脉,一般情况差异明显(P>0.05)。K组1%氯胺酮(用0.9%氯化钠注射液稀释至10ml)0.3mg·kg-1,接着丙泊酚1.5mg·kg-1,iv。,F组先用芬太尼1μg·kg-1,iv,接着用丙泊酚2.5mg·kg-1,iv,两组患者均在意识丧失、呼之不应后开始手术。手术时间过长者追加丙泊酚1mg·kg-1,iv,但不列入统计范围。观察两组患者的麻醉诱导时间,丙泊酚首次给药量,SBP、DBP、HR、RR变化及并发症发生情况。结果:K组患者丙泊酚用量明显少于F组,并发症发生率明显低于F组,组间差异显著(P<0.05);两组患者的清醒时间和离院时间差异不明显(P>0.05)。结论:小剂量氯胺酮复合丙泊酚是一种较理想的无痛人流术的麻醉方法。

Objective： To observe the dose and the complications of propofol on artificial abortion by using small doses of ketamine and propofol. Method： 300 patients willing to accept the painless artificial abortion were randomly divided into two groups： ketamine group （K） and fentanyl group （F） , which were both intravenously injected through their upper limbs without great changes generally（ P 〉 0.05 ）. The patients of Group K were intravenously injected with 1% ketamine （diluted with normal saline to 10 ml）0.3 mg/kg and then with propofol 1.5 mg/kg. The patients of Group F were intravenously injected ＂with fentanyl 1 ug/kg and then with propofol 2.5 mg/kg. All the patients were operated on when they were unconscious and could not answer when calling them. Those who had long operations were added with propofol （ 1 mg/kg）. Their induction time, dose of propofol for the first time, changes of SBP, DBP, HR, RR, time of coming back to life and departure from hospital and also all the complications such as dizziness, nausea, vomiting, choke, pain in the back of hand, sudden stop of breath and nervous disorder （dream, lethargy,delirium, dysphoria ） and limb activities were observed. Result： The dose of propofol of the group K was obviously smaller than that of the group F and the symptom frequency was also much slower. There was obvious difference between the two groups （ P 〈 0.05 ） but the time of coming back to life and departure from hospital remained unchanged （ P 〉 0.05 ）. Conclusion ： Ketamine and propofol with small dose is an ideal anesthesia method in artificial abortion.