目的 探讨不同小剂量氯胺酮复合丙泊酚在人工流产手术中的麻醉镇痛效果及其安全、有效性.方法 选择120例ASAⅠ~Ⅱ级,妊娠6~9周且自愿终止妊娠孕妇,随机分成4组.A组（对照组）静注生理盐水5 mL,1 min后静注丙泊酚2 mg/kg;B组静注氯胺酮0.2 mg/kg、丙泊酚1.5～2 mg/kg;C组静注氯胺酮0.3 mg/kg、丙泊酚1.5～2 mg/kg;D组静注氯胺酮0.4 mg/kg、丙泊酚1.5～2 mg/kg.观察术中各组SBP、DBP、HR、SpO2的变化及麻醉效果、术后镇痛效果,记录各组丙泊酚用药总量、清醒时间、离院时间及术后恶心、呕吐等并发症.结果 术中丙泊酚总用量A、B两组明显多于C、D组（P＜0.05）;术后清醒时间D组明显长于A组（P＜0.05）,离室时间4组差异无统计学意义.A、B两组丙泊酚诱导后2 min SBP、DBP、HR与诱导前有显著差异（P＜0.05）,C、D两组麻醉过程中心率、血压比较平稳.B、C、D 3组麻醉、镇痛效果明显优于A组,术后恶心反应也少于A组（P＜0.05）.结论 小剂量氯胺酮与丙泊酚合用于人工流产手术,麻醉镇痛效果好,并发症少,0.3 mg/kg氯胺酮与丙泊酚复合应用尤为安全、有效.
Objective To study the anesthesia effect, safety and effectiveness of different small doses of ketamine combined with propofol applied to induced abortion. Methods 120 cases of pregnant women undergoing voluntary termination of pregnancy with a gestational age of 6-9 weeks, ASA Ⅰ-Ⅱ level, were selected and randomly divided into 4 groups. By intravenous injection, saline 5ml, then propofol 2mg/kg after 1 min were given to group A （control group）, ketamine 0.2 mg/kg and propofol 1.5-2 mg/kg were given to group B, ketamine 0.3mg/kg and propofol 1.5-2mg/kg were given to group C, and ketamine 0.4 mg/kg and propofol 1.5- 2mg/kg were given to group D. Each group＇s intraoperative changes of SBP, DBP, HR, SpO2, anesthetic effect and postoperative analgesia were observed, and the total amount of propofol administration, time of consciousness, time of discharge, postoperative nausea, vomit and other complications were recorded. Results The intraoperative total amounts of propofol used in group A and group B were significantly more than those used in group C and D （P〈0.05）. The time of consciousness in group D was obviously longer than that in group A（P〈0.05）. But no significant difference between four groups in time of discharge. For group A and group B, there were significantly differences before the induction of prepofol and 2 min after the induction in SBP, DBP, HR （P〈0.05）. The heart rate and blood pressure of group C and group D during the anesthetic process were relatively stable. Group B, group C and group D showed much better anesthetic effect and analgesic effect and less postoperative nausea than group A did （P〈0.05） . Conclusion Small dose of ketamine combined with propofol for induced abortion have better anesthetic effect and analgesic effect and fewer complications, and ketamin 0.3mg/kg combined with plropofol are especially safe and effective.
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