小剂量氯胺酮复合曲马多辅助腰硬联合麻醉用于宫腹腔镜手术的临床观察

The application of low-dose ketamine combined with tramadol auxiliary for combined spinal-epidural anesthesia in combination of hysteroscopy and laparoscopy

目的:观察小剂量氯胺酮复合曲马多辅助腰硬联合麻醉在宫腹腔镜手术中的麻醉效果。方法:女性不孕症行宫腹腔镜手术60例,随机分为A、B两组。两组对象均采用腰硬联合麻醉,于切皮前10min常规静脉滴注曲马多1mg/kg,氟哌利多0.05mg/kg,A组气腹时加用氯胺酮0.5mg/kg,术中视受术者气腹耐受情况追加氯胺酮。常规面罩吸氧,连续监测心电图(ECG)、心率(HR)、收缩压(SBP)、舒张压(DBP)、平均动脉血压(MAP)、血氧饱和度(SpO2)。记录气腹前和气腹后15min、30min、45min及放气后监测参数;记录术中肢体扭动、气腹不适感及意识状态;了解术后24h内头痛、恶心、呕吐、精神副作用等不良反应;术后24h调查受术者麻醉满意度。结果:两组对象血压、心率比较差异有统计学意义(P<0.05),A组血压波动较大,但仍在正常值范围;体动、气腹不适感比较B组明显多于A组,镇静、镇痛效果A组优于B组(P<0.01);麻醉满意度调查A组高于B组(P<0.01)。结论:小剂量氯胺酮复合曲马多辅助腰硬联合麻醉镇静镇痛效果满意,是宫腹腔镜联合手术可行的麻醉方法。

Objective：To explore the analgesia effect of low-dose ketamine combined with tramadol auxiliary for combined spinal-epidural anesthesia in combination of hysteroscopy and laparoscopy.Methods：Sixty infertile women underwent combination of hysteroscopy and laparoscopic surgery were randomly divided into two groups.The women in both groups were given combined spinal-epidural anesthesia,and conventionally intravenous tramadol （1mg/kg） and droperidol （0.05mg/kg） 10 minutes before incision of the skin.The women in group A were given ketamine （0.5mg/kg） when undergoing pneumoperitoneum.And ketamine was added according to their tolerance.Oxygen was usually given by mask.Electrocardiography,heart rate,systolic pressure,diastolic pressure,mean arterial pressure and oxyhemoglobin saturation were monitored continuously.The occurrence of body twisting,uncomfortableness and consciousness were observed.Adverse reactions such as headache,nausea,vomiting and so on and their satisfaction with analgesia were evaluated 24 hours after the surgery.Results：There were significant differences in blood pressure and heart rate in the two groups （P〈0.05）.Blood pressure of the women in group A had a visible fluctuation,but still within the normal reference range.The body twisting and uncomfortableness were more common in the women of group B.The effects of sedation and analgesia in group A were better than those of group B （P〈0.01）.More satisfaction was found in group A according to the survey results （P〈0.01）.Conclusion：Low-dose ketamine combined with tramadol auxiliary for combined spinal-epidural anesthesia is a feasible anesthesia method in combination of hysteroscopy and laparoscopy,which can achieve satisfactory effects of sedation and analgesia.