丙泊酚分别联合瑞芬太尼、氯胺酮在无痛人工流产中麻醉效果比较

目的比较丙泊酚分别联合瑞芬太尼、氯胺酮用于人工流产的麻醉效果。方法60例需要无痛人工流产的病人随机分两组（A组和B组），A组分别静脉注射丙泊酚（1～2mg／kg）与瑞芬太尼（0．5-1．0μg／kg）；B组：丙泊酚（1～2ms／kg）与氯胺酮（0．2～0．4mg／kg）组，观察两组麻醉效果、麻醉、手术及恢复情况、循环和呼吸变化。结果两组麻醉效果比较无显著性差异（P〉0．05）；两组患者的苏醒时间、离院时间、出血量均无显著性差异（P〉0．05），A组的诱导时间和定向力恢复时间明显短于B组（P〈0．05）；A组较B组呼吸循环抑制明显，血氧饱和度、心率、平均动脉压下降显著，呼气末CO2上升（P〈0．05）。结论两组镇静镇痛程度相仿，效果优良，均可用于无痛人工流产的麻醉，但丙泊酚联合瑞芬太尼应注意呼吸的管理。

A comparison of anesthetic effect of propofol combined with remifentanil, ketamine for painless artificial abortion

Objective To compare the anesthetic effect of propofol combined with remifentanil or ketamine for painless artificial abortion. Methods 60 patients with painless artificial abortion were randomly divided into two groups （ A and B group）. Patients in group A were treated with intravenous administration of propofol （ 1 - 2 mg/kg） plus remifentanil （0.5 - 1.0 μg/kg ） and patients in group B were treated with propofol （1 - 2 mg/kg） plus ketamine （0.2 -0.4 mg/kg）. Narcotic effect of anesthesia, surgical and recovery condition, and changes in circulation and breathing were observed in patients of these two groups. Results The difference in anesthetic effect of paients in two groups was not significant （ P 〉 0.05） ; and the difference in time for wake up, time for discharge from hospital and blood loss during operation in patients of these two groups were also not significant （ P 〉 0.05 ）. The induction and orientation recovery time of patients in group A was shorter than that of patients in group B （ P 〈 0.05 ）. The inhibition of breathing and circulation in patients of group A was significant than that of patients in group B, SpO2 , HR and MAP of patients in group A were significantly decreased than those of group B, but FtCO2 was significantly increased in patients of group A （ P 〈 0.05）. Conclusion The level of sedation of analgesia was similar in patients of these two groups, therefore these two combinations can be used for painless artificial abortion, but attention should be paid to respiratory management in anesthetic method with propofol and remifentanil.