小剂量氯胺酮显著改善人工流产术的麻醉效果

Low-dose ketamine improves anesthetic effect during dilatation and curettage

目的观察小剂量氯胺酮复合丙泊酚及芬太尼在门诊人工流产术中的麻醉和术后镇痛效果以及并发症的发生情况。方法选择781例行无痛人工流产的患者,分为3组:A组,264例,芬太尼1.0μg/kg+丙泊酚1.5mg/kg;B组,276例,芬太尼1.0μg/kg+氯胺酮0.2mg/kg+丙泊酚1.5mg/kg;C组,241例,芬太尼1.0μg/kg+氯胺酮0.3mg/kg+丙泊酚1.5mg/kg。术中出现体动时,追加丙泊酚20～40mg/次。观察平均动脉压(MAP)、心率(HR)、最低脉搏氧分压(SpO2)值,丙泊酚总消耗量、清醒情况、术中麻醉效果、术后6h镇痛效果及术后并发症的发生情况。结果 3组间术前、术中、术后的MAP、HR以及术中最低SpO2值的差异均无统计学意义(P值均>0.05),3组间丙泊酚总量的差异有统计学意义(P<0.05),A组丙泊酚用量最多[(131.59±30.12)mg],B组最少[(89.13±29.72)mg]。B组术后恢复良好率最高(93.48%),术后恶心(6.88%)、呕吐(2.17%)的发生率最低(P值均<0.05);B、C组术后均未发生疼痛,而A组疼痛发生率也较低,仅为1.14%。结论小剂量氯胺酮复合丙泊酚及芬太尼术中麻醉的效果良好,术后镇痛效果佳,恶心、呕吐发生率较小。

Objective To observe the effects of low-dose ketamine combined with propofol and fentanyl on anesthesia,postoperative analgesia and complications in outpatient dilatation and curettage.Methods Totally 781 patients undergoing dilatation and curettage without pain were divided into 3 groups：Group A （propofol 1.5 mg/kg＋ fentanyl 1.0 μg/kg,n=264）,Group B （propofol 1.5 mg/kg＋ fentanyl 1.0 μg/kg ＋ ketamine 0.2 mg/kg,n=276）,and Group C （propofol 1.5 mg/kg＋ fentanyl 1.0 μg/kg ＋ ketamine 0.3 mg/kg,n=241）.Propofol （20-40） mg was given if there was body movement during surgery.The changes of MAP and HR were recorded;the lowest value of SpO2,total consumption of propofol,level of post-operative consciousness,effect of anesthesia during surgery,effect of analgesia and complications within 6 hours after surgery were also observed.Results There were no significant differences in MAP,HR,lowest SpO2 among the three groups before,during and after operation （P0.05）.There were significant differences in the total volume of propofol among the three groups （P0.05）.The largest propofol dosage was （131.59±30.12） mg in Group A,and the smallest dosage was （89.13±29.72） mg in Group C.Group B had the highest recovery rate from anesthesia （93.48%）,and lowest rate of postoperative nausea （6.88%） and rate of postoperative vomiting （2.17%,P0.05）.There was no incidence of pain within 6 hours after surgery in Group C and Group B,and the incidence of pain in Group A was also low （1.14%）.Conclusion Low-dose ketamine combined with propofol and fentanyl has a better analgesic effect for dilatation and curettage,with lower rates of postoperative nausea and vomiting.（Shanghai Med J,2010,33：322-324）