氯胺酮在人工流产术中的镇痛效果观察

目的 :探讨小剂量氯胺酮能否有效加强异丙酚对初孕妇行人流术的镇痛作用。方法 :1 80例病例随机等分为Ⅰ、Ⅱ两组 ,Ⅰ组单纯采用异丙酚诱导和维持麻醉 ;Ⅱ组先静脉给予 0 .1mg·kg- 1 氯胺酮 ,再给予异丙酚诱导和维持麻醉。观察两组病例麻醉诱导的异丙酚用量、术中的疼痛反应、清醒和离院时间、清醒后下腹坠痛发生情况、子宫回缩及出血情况。结果 :两组比较 ,Ⅱ组异丙酚麻醉诱导用量较Ⅰ组减少约 2 0 % (P <0 .0 1 ) ;Ⅱ组镇痛效果显著优于Ⅰ组 ,术中躯体反应轻微 ,尤其在行扩宫阶段镇痛优势显著 ;Ⅱ组清醒时间略有延长 ,平均延长不到 1min ,清醒后离院时间两组无显著差异 ;清醒后下腹坠痛发生情况Ⅰ组多于Ⅱ组 ,而且Ⅱ组疼痛程度较轻 ;子宫回缩及出血情况两组无显著差异。结论 :小剂量氯胺酮能有效地加强异丙酚在初孕妇行无痛人流术中的镇痛作用 ,可减少异丙酚麻醉诱导用量 ,又不增加副反应的发生。

Clinical observation on analgesic effect of ketamine in induced abortion

Purpose:To explore whether small dose ketamine can enhence analgesic effect of propofol in induced abortion of early pregnancy.Method:180 cases were devided randomly into 2 groups(90 cases for each group). Group Ⅰ adopted propofol anaesthesia,while Group Ⅱ adopted propofol anaesthesia after received ketamine(iv,0.1mg·kg -1 ).Induction dose of propofol,pain during operation,recovery time and time of leaving hospital after recovery,retraction of uterus and the amount of bleeding were assessed.Result:Induction dose of propofol in Group Ⅱ were reduced by 20% comparing with that in Group Ⅰ(P<0.01);Analgesic effects in Group Ⅱ were obviously better than that in Group Ⅰ;Recovery time in Group Ⅱ were sligtly longer than that in Group Ⅰ,there were no significant differences in time of leaving hospital after recovery between Group Ⅰ and Group Ⅱ;The rate of bearing down pain in Group Ⅰ was higher than that in Group Ⅱ,pain of the patients in Group Ⅱ were slight;There were no significant differences in retraction of uterus and the amount of bleeding between Group Ⅰ and Group Ⅱ.Conclusion:Small dose ketamine combined with propofol can enhence analgesic effect of propofol in induced abortion of early pregnancy,this combination can reduce the dosage of propofol,and no more side effects are to be occur.