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目的通过对三种麻醉方法优缺点的比较,指导临床选择相对理想的方法用于无痛人流术。方法选择门诊无痛人流患者90例,随机分成异丙酚(A组,n=30)、异丙酚复合芬太尼(B组,n=30)、异丙酚复合氯胺酮(C组,n=30)。记录给药前后各时点的OAA/S评分、平均动脉压(MAP)、心率(HR)、血氧饱和度(SpO2)以及术中异丙酚用量、苏醒时间和苏醒质量。结果三组OAA/S评分在给药后及整个手术期间均明显降低,与自身给药前相比差异有统计学意义(P<0.01);给药后,A、B两组的MAP、HR及SpO2均有不同程度的下降,与自身给药前相比差异有统计学意义(P<0.05),C组无明显变化;术中异丙酚的用量A组明显多于B、C两组,差异有统计学意义(P<0.01),B组多于C组,差异有统计学意义(P<0.05);苏醒时间C组长于A、B两组,差异有统计学意义(P<0.05);苏醒质量B、C两组好于A组,A组部分患者醒后诉说下腹疼痛。结论三种方法均能达到较好的镇静水平,异丙酚复合氯胺酮对患者MAP、HR和SpO2的影响较其它两种方法小,异丙酚的用量也更少,苏醒时间稍延长,但苏醒质量更佳,是一种更为理想的无痛人流术的麻醉方法。
Objective To compare the advantages and disadvantages of the three anesthetic methods and guide the clinical choice of the relatively ideal method for painless abortion. Methods Ninety patients with painless outpatients were randomly divided into two groups: propofol (group A, n = 30), propofol combined with fentanyl (group B, n = 30), propofol combined ketamine = 30). The OAA / S score, mean arterial pressure (MAP), heart rate (HR), oxygen saturation (SpO2) and intraoperative propofol dosage, recovery time and awakening quality were recorded before and after administration. Results The OAA / S scores of the three groups were significantly decreased after administration and throughout the operation period, with statistical significance (P <0.01). After administration, MAP and HR in groups A and B (P <0.05), but there was no significant change in group C. The dosage of propofol in group A was significantly higher than that in group B and C , The difference was statistically significant (P <0.01), B group more than C group, the difference was statistically significant (P <0.05); awake time C group longer than A, B two groups, the difference was statistically significant (P <0.05 ); Awakening quality B, C two groups better than A group, some patients in group A wake up complained of abdominal pain. Conclusions All the three methods can achieve better sedation level. The effect of propofol combined ketamine on MAP, HR and SpO2 in patients is smaller than that in the other two methods, the dosage of propofol is less, the recovery time is slightly longer, Better quality, is a more ideal method of painless abortion anesthesia.