大面积重度烧伤后多次削痂植皮麻醉用药量的临床研究

Clinical study on the anesthetic dosage during tangential excision in patients with extensive severe burn

目的 探讨大面积重度烧伤后患者多次削痂植皮麻醉中麻醉用药量变化。方法 88例烧伤面积 >5 0 %以深Ⅱ～Ⅲ度烧伤为主的患者 ,随机分为二次植皮组及三次植皮组 ,以咪达唑仑、氯胺酮麻醉诱导 ,静脉以 4mg·kg- 1 ·h- 1 氯胺酮维持麻醉。结果 二次组与三次组患者手术麻醉用药量有明显不同 ,三次组患者第一次与第三次手术麻醉用药量差异明显 ,P <0 .0 1。结论 多次削痂植皮手术麻醉时氯胺酮用药量变化 ,主要为循环的改变 ,低蛋白血症及药物在肝内Ⅱ相代谢 ,肾药物排泄半衰期缩短密切相关。

Objective To investigate the anesthetic dosage during tangential excision in patients with extensive severe burn.Methods 88 patients with extensive burn area>50% were randomly divided into two groups,2 times skin grafting group and 3 times skin grafting group.Anesthesia was induced by midazolam and ketamine,and maintained by ketamine 4 mg·kg -1 ·h -1 .Results There was a obvious difference in the anesthetic dosage between 2 times skin grafting group and 3 times skin grafting group,and there was a significant difference in anesthetic dosage between first operation and third operation in 3 times skin grafting group (P<0.01).Conclusion When tangential excision and skin grafting perform repeatedly,the changes of dosage of ketamine are closely related to the alterations of circulation,low proteinemia, second grade metabolism in liver and the shortening of half life period of drug excretion in kidney.