小剂量氯胺酮伍用丙泊酚-曲马多在无痛人流术中的应用

The Application of Small Dose of Ketamine Using in Indodence Induced Abortion

目的观察小剂量氯胺酮伍用丙泊酚—曲马多在无痛人流术中临床效果和不良反应。方法随机选择450例ASAI-II级无全身性疾病、无镇痛药成瘾史、无精神症状的早孕妇女分为三组,分别给予A组:丙泊酚1.5mg/kg静注;B组:曲马多1mg/kg+丙泊酚1.5mg/kg静注;C组:氯胺酮0.15mg/kg+曲马多1mg/kg+丙泊酚1mg/kg静注;宫颈扩张或术中病人臀部扭动抵抗时,酌情静注丙泊酚。观察麻醉前后生命体征、镇痛效果、丙泊酚用量、清醒时间、离院时间、出血量、术后恶心呕吐、精神症状、患者满意度。结果不同药物配伍,镇痛效果有显著性差异,C组好于B组,B组好于A组;丙泊酚用量三组有显著性差异,C组用量<B组用量<A组用量;清醒时间、离院时间,C组与A组、B组比较有显著性差异,A组与B组比较有显著性差异;三组出血量无显著性差异;B组、C组满意度高。结论小剂量氯胺酮伍用丙泊酚—曲马多用于无痛人流术,镇痛效果好,丙泊酚用量少,苏醒快,术后充分抑制宫缩疼痛,无不良反应,患者满意度高,是较为适合用于无痛人流术的一种麻醉配伍方法。

Objective To study the effect and adverse effect of using small dose of ketamine combined with Tramadoe in the indodence induced abortion. Methods 450 cases of early pregnant women at ASA Ⅰ-Ⅱ level, who were not addict to analgesic and without psychological problem, were randomly divided into three groups. Each individual was given intravenous injection of propofol 1.5 mg/kg for group A, mainline, Tramadol 1 mg/kg ＋ propofol 1.5 mg/kg for group B, Ketamine 0.15 mg/kg ＋ Tramadol 1 mg/kg ＋ propofol 1 mg/kg for group C. Intravenous injection of propofol （the dose was based on the clinical judgment） was given to those with uterus expansion or showed buttocks twist during operation. Vital signs, analgesic effect, dose of propofol, time with consciousness, time of discharge, the amounts of blood lost, nausea, vomiting and psychological condition were observed before and after operation. Results The effects of different combination of drugs were remarkably different, group C showed the best effect, while group B was better than A. The total amounts of drugs used in different groups were very different. The does used in group C was the least, while the does used in group B was less than A. The time with consciousness and the time of discharge of the patients were quite different between group C and the other groups. There was no significant difference of the amount of blood lost between the three groups. Both group B and C showed high degree of satisfaction. Conclusion Small dose Ketamine combined with Tramadol and propofol using in indoderce induced abortion have better analgesic effect ; use lower does of propofol ; can quickly regain consciousness ; can fully control the pain caused by the contraction of uterus after operation ; have no adverse effect and high degree of satisfaction. Therefore, it is a better anesthetic formulation for indodence induced abortion.