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| 摘要 目的 研究丙泊酚不同配伍在门诊人工流产术中的应用。方法 早孕妇女120例,ASA I-II级,随机分为两组。A组(试验组)静注芬太尼1μg/kg及丙泊酚1.5mg/kg。B组(对照组)静注氯胺酮0.2mg/kg及丙泊酚1.5mg/kg。术中根据患者体动追加丙泊酚，丙泊酚均予45～60秒内推入。观察:(1)手术、清醒、离院时间及丙泊酚用量；(2)术中HR、BP、SpO2变化;(3)副作用发生率。结果 (1)两组清醒、手术、离院时间及丙泊酚用量无显著性差异。(2)A组HR及SBP注药后下降，下降幅度未超过基础值的20%，两组相比有显著性差异(P< 0.05)。A组60%患者术中出现呼吸抑制(RR<10次/分)。(3)注射痛率A组44.4%,B组20%(P<0.05)；术中做梦率B组60%，A组22.2%(P<0.001)；术后嗜睡发生率B组40%,A组11.1%(P<0.01)；均有显著性差异。结论 氯胺酮配伍丙泊酚减少心血管系统抑制，减轻副作用发生率，适用于门诊人工流产术。 关键词 丙泊酚 人工流产 Different compatibility of medicines with propofol for outpatient suction termination of pregnancy.XU Min-g ，ZHANG Wanfen.(Department of Anesthesiology，The Eighth People's Hospital of Shanghai，Shanghai 200235 China) Abstract Objective To explore different compatibility of medicines with propofol for outpatient suction term-ination of pregnancy.Methods Early pregent women 120，ASAI-II，were randomly divided into two groups.Group A (control group) was administrated 1μg/kg fentanyl with propofol 1.5mg/kg.Group B (compare group) was 0.2mg/kg ketamine with propofol 1.5mg/kg.In operation， according to body movement，propofol was added in 45～60s.Sur-gical time 、recovery time、depart time and the dosage of propofol， HR、BP、SpO2，occurence of side effects were assessed.Results There were no difference between two groups in average surgical time、recovery time、depa-rt time and the dosage of propofol.HR and SBP were decreased significantly in group A compared with that in group B(P<0.05)，but the reduced degree didn't surpass 20% of the basic value in group A.Respiratory depression inciden-ce of group A was 60%(RR<10bpm). The rate of injection pain was high in group A(44.4% vs 20%)(P<0.05).The in-cidences of dream were significantly higher in group B(60%)than that in group A(P<0.001).Similarly，the rate of do-ze was also significantly higher in group B(40%)than that in group A(11.1%)(P<0.01).Conclusion Ketamine comp-atible with propofol may lessen the depression of cardiovascular system and reduce the occurrence ratio of side effec-ts,which was suitable to outpatient suction termination of pregnancy. Key words Propofol;Suction termination of pregnancy 丙泊酚是较新的静脉麻醉诱导药，具有起效快、苏醒快的优点，目前广泛应用于门诊手术［1］。但其镇痛作用微弱，使用时伴有注射痛及中枢抑制等不良反应。本文比较丙泊酚与不同药物配伍在门诊人工流产术中的应用，研究合适的配伍方法。 1 资料和方法 1.1 一般情况 选择早孕患者120例,ASA I～II级，无药物过敏史，年龄20～33岁，体重42～60kg ，妊娠天数38～68天。随机分成两组，每组各60例，A组行芬太尼、丙泊酚麻醉。B组行氯胺酮、丙泊酚麻醉。 1.2 麻醉方法 患者均无术前用药。入室连接Detax多功能监护仪监测HR、BP、SpO2。开放上肢静脉。A组先静注1μg/kg芬太尼，B组先静注0.2mg/kg氯胺酮，随后予1.5mg/kg丙泊酚,患者入睡后即开始手术。术中根据患者体动追加丙泊酚,每次0.5mg/kg，均予45～60秒内推入。SpO2≤90%时予面罩加压给氧，当SpO2≥95%时停止加压给氧。 1.3 监测 记录手术时间，清醒时间(手术结束至意识恢复，意识恢复标准：对正常声音呼名反应迅速)，离院时间(术毕至离院，离院标准：认知精神功能完全恢复，符合麻醉后出院标准9分以上)［1］及丙泊酚总用药量。记录注药前，注药后1min、2min、3min，手术结束及清醒六时点HR、BP、SpO2值。记录注射痛、呼吸抑制等副作用。 1.4 统计分析 各组数据均采用均数±标准差(x±s)表示,SPSS10.0软件包处理数据。计量资料组内采用方差分析，组间采用t检验。计数资料采用χ2检验。P<0.01和P＜0.05为有非常显著差异和显著差异。 2 结果 两组一般情况无显著差异(表1)。清醒时间、手术时间、离院时间与丙泊酚总用药量两组无显著差异(表2)。
B组HR、BP注药前后略有升高,但无显著差异。呼吸抑制微弱。与A组比较，HR在注药后1min、术毕时有显著差异，注药后2min、3min有非常显著差异，SBP在注药后2min有显著差异(表3)。B组有一例术后恶心呕吐。A组注射痛发生率明显高于B组(P<0.05)。B组27例回忆术中做梦,18例术后嗜睡；与A组10例、5例相比有非常显著差异。两组分别有5和9例患者有精神症状，表现为话多，组间无显著差异(表4)。 表3-1 两组病人五个时点HR、BP、SpO2变化
与A组比较，*P＜0.05**P＜0.01 |
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