小剂量氯胺酮与异丙酚合用在无痛人流中的观察

目的小剂量氯胺酮与异丙酚合用在无痛人流中的观察。方法100例预行无痛人流者随机分两组，A组为单纯应用异丙酚完成手术操作组，B组为异丙酚复合小剂量氯胺酮组。A组以3．5mg·kg^-1·min^-1静脉注射异丙酚，待病人睫毛反射消失开始操作，至扩张宫颈无肢动反应停药。若患者出现肢动反应，追加异丙酚至肢动反应消失。B组在给异丙酚前以小剂量氯胺酮静脉持续输注20μg·kg^-1·min^-1（1．2mg／kg／h）。持续输注1分钟后同A组方法静注异丙酚，至手术操作结束停止输注氯胺酮。观察并记录异丙酚和氯胺酮用量；神志消失时间、手术时间以及意识和定向力恢复的时间。结果A组病人神志消失时间为（78±24）s，手术时间（198±24）s，意识恢复时间（390±12）s，定向力恢复时间（450±21）s，异丙酚首次量（16．2±2.7）ml，总剂量（17．8±4．7）ml。实际给药速率为（2．5±0．6）mg·kg^-1·min^-1。B组则相应的为（45±9）s，（177±13）s，（355±37）s，（415±21）s，（14．3±1．9）ml，（14．3±1．9）ml，（1．7±0．5）mg·kg^-1·min^-1；氯胺酮用量为（2．8±0．8）mg。结论单纯应用异丙酚可以满足手术的需要，但若伍用一些镇痛药（如小剂量氯胺酮）麻醉效果会更好，且苏醒质量也更好。异丙酚的灵活应用值得探索研究。

Effect of minidose ketamine combined with propofol in Induced abortion without pain

Objective To observe the effect of minidose ketamine combined with propofol in induced abortion without pain. Methods 100 patients who would undergo induced abortion without pain were randomly divided into two groups, group of only propofol （group A） and group of minidose ketamine combined with propofol （group B）. The patients of group A were i. v. only propofol with 3.5 mg · kg^-1 · min^-1 until lash reflex disappear and at the same time operation star. When limbs motivated to boost propofol. The patients of group B were pumped minidose ketamine with 20 μg · kg^-1· min^-1 （1.2 mg/kg/h） until to end of operation. After pumping one minutes, they were i.v. propofol alike group A. To record the times of disappear their consciousness, operation and recovery their consciousness of orientation; the dosage of propofol and ketamine. Results The times of Group A of disappear their consciousness, operation and recovery their consciousness and recovery their orientation were （78 ± 24） s, （198±24）s, （390±12）s, （450±21）s respectively; but the times of group B were （45±9）s,（177±13） s, （ 355± 37） s, （415 ± 21 ） s respectively. The dosage of propofol and practical administration velocity was （17.8±4.7）ml and （2.5±0.6）mg · kg^-1 · min^-1 in group A, but （14.3±1.9）mland （1.7±0.5）mg · kg^-1 · min^-1 in group B. The dosage of ketamine was （2.8±0.8）mg. Conclusions Only propofol can be satisfied with induced abortion without pain, but it combined with analgesic as minidose ketamine can have surely better anesthesia effects and better recovery quality. Active use of Propofol deserves exploration.