丙泊酚复合麻醉用于无痛人流的临床研究

Clinical study on selection of combined anesthesia of propofol used in artificial abortion

目的 :对丙泊酚与 3种麻醉性镇痛药复合应用于人工流产进行临床观察。方法 :40例早期妊娠行人工流产手术患者 ,随机分成丙泊酚组 (P组 )、丙泊酚加芬太尼组 (F组 )、丙泊酚加氯胺酮组 (K组 )和丙泊酚加哌替啶组 (D组 ) ;每组 10例。P组静注丙泊酚 2 .5mg/kg ,F ,K ,D组静注丙泊酚 1.5mg/kg分别加芬太尼 2 μg/kg ,氯胺酮 1mg/kg ,哌替啶 2mg/kg麻醉诱导 ;待意识消失后 ,均以丙泊酚 0 .3mg/ (kg·min)维持麻醉。结果 :F ,K组起效时间明显快于P组 (P <0 .0 1) ,而D组变化不明显 ;苏醒时间除K组较P组延长外 ,其余均无明显变化 ;呼吸循环的变化各组间无显著差异。F ,K组术中无 1例发生肢体活动 ,而P ,D组发生率分别为 10 0 %和 6 0 %。结论 :芬太尼、氯胺酮对丙泊酚的药效学有加强作用 ,而哌替啶此作用不明显 ;丙泊酚复合小剂量芬太尼静脉麻醉用于门诊无痛人工流产手术是一种较为合理、安全可行的麻醉方法。

Objectives:Propofol single anesthesia and 3 kinds of combined anesthesia composed of propofol and anesthetic analgesies used in artificial abortion were studied.Methods:40 patients of early pregnancy to receive artificial abortion were randomly and equally divided to receive one of the following anesthesia:2.5 mg/kg propofol(P),1.5 mg/kg propofol +2μg/kg fentanyl(F),1.5 mg/kg propofol+1mg/kg ketamine(K),and 1.5 mg/kg propofol+2mg/kg pethidine(D).After loss of sensation,0.3 mg/kg propofol was used for maintaining anesthesia.Results:The onset of anesthetic action in group F and K was significantly quicker than that of group P( P >0.01) and no obvious change in group D.No significant difference in recovery time was observed between groups except group K that was extended in comparison with P.No obvious respiratory and circulatory differences were observed between groups.Nobody movement was found in group F and K while a body movement rate of 100% and 60% was found in group P and D respectively.Conclusions:The anesthetic effect of propofol may be enhanced by ketamine and fentanyl but not by pethidine.Propofol in combination with small dose of fentanyl is a reasonable,safe,and practicable anesthetic regimen for analgesic artificial abortion of out patients.