异丙酚复合小剂量氯胺酮用于宫颈锥切手术的麻醉

Effects of the coadministration of propofol and small-dose ketamine for conization of cervix

目的比较异丙酚复合小剂量氯胺酮与单独应用异丙酚在宫颈锥切手术中的麻醉效果。方法将麻醉下行宫颈锥切手术的门诊患者80例,随机分为异丙酚组(A组)和异丙酚复合小剂量氯胺酮组(B组),每组40例。A组缓慢静脉注射异丙酚,B组先静脉注射氯胺酮0.2 mg.kg-1,再缓慢静脉注射异丙酚。至患者意识消失后,再注射已用异丙酚的半量后开始宫颈锥切手术。术中根据患者的体动反应适当追加异丙酚。B组中,手术时间长于15 min者额外追加氯胺酮0.2 mg.kg-1。记录患者的年龄、体重、术中生命体征、手术时间、麻醉恢复时间、异丙酚的总用药量、术中体动反应及术中术后其他副作用。结果①A组和B组异丙酚用量有显著性差异,分别为(30.7±9.9)ml和(24.2±6.5)ml(P<0.01)。术中体动反应A组30%,B组10%,2组比较有显著性差异(P<0.05)。②术中2组心率皆有所降低,但差异不明显。2组患者麻醉后血压与麻醉前相比显著降低,B组血压降低幅度较A组小。③2组皆无患者发生呼吸、循环严重并发症。结论异丙酚复合小剂量氯胺酮可安全有效地用于宫颈锥切手术的麻醉,患者术中血压变化相对较小,体动反应较少,不增加患者的麻醉恢复时间,且可减少异丙酚的用量。

Objective To compare the anesthetic effects between the coadministration of propofol and small - dose ketamine and the use of propofol alone for conization of the cervix. Methods Eighty outpatients scheduled for elective conization of cervix under anesthesia were randomly allocated to two groups （ n = 40 each） ： group A, to receive propofol anesthesia; group B, under propofol - ketamine anesthesia. In group A, the anesthesia was induced by slowly giving a certain dose of propofol. In group B, ketamine 0.2 mg/kg i.v. was given before the use of intravenous propofol. When the patients lost consciousness, and half of the dosage of propofol had been given, the operation was started. Additional dose of propofol 1.0 mg/kg could be administered to maintain anesthesia, when necessary. Another dose of ketamine 0.2 mg · kg^-1 was given, if the operation time was beyond 15 min in group B. Observations were made over body weight and age, vital signs, operation time, recovery time, amount of propofol consumed, responsive body movements and side effects. Results No significant differences were found between the two groups in operation time and recovery time, but the dose of propofol was significantly bigger in group A than in group B [ （ 30.7 ± 9.9 ） ml vs. （ 24.2 ± 6.5 ） ml, P 〈 0.01 ]. The frequency of body movement was higher in group A （30%） than in group B （ 10% ）. The arterial was better pressured in group B than in group A. There were no severe side effects in the two groups. Conclusion Coadministration of propofol and small - dose ketamine can provide safe and effective anesthesia in patients undergoing loop eleetrosurgieal excision procedure for cervical intraepithelial neoplasia, preserving stable hemodynamies, leaving less responsive body movements and requiring smaller dose of propofol.