吸毒者胃肠道金属异物取出术的麻醉处理

Anesthesia of druggers in abdomen surgery.

目的 研究吸毒者剖腹探查术的麻醉处理。方法 1 0 8例吸毒患者分为两组 ,Ⅰ组 (92例 )静脉注射氟哌利多0 .1mg/kg、2 .5 %硫喷妥钠 5～ 6mg/kg、芬太尼 4 μg/kg、氯化琥珀胆碱 2mg/kg后气管插管 ,以 1 %～ 2 %异氟烷、1 .6 %普鲁卡因 +0 .1 %琥珀胆碱复合液维持麻醉 ,术中间断追加芬太尼 ;Ⅱ组 (1 6例 )术前 1h口服可乐定 5 μg/kg ,静脉注射氯胺酮2mg/kg、氯化琥珀胆碱 2mg/kg后气管插管 ,以 1 %～ 2 %异氟烷、1 %普鲁卡因 +0 .1 %氯胺酮 +0 .1 %琥珀胆碱复合液维持麻醉 ,术中适量追加芬太尼。连续监测无创血压、心电图、脉搏血氧饱和度 (SpO2 )和芬太尼用量。结果 与术前比较 ,Ⅰ组平均动脉压 (MAP)、心率 (HR)明显增高 (P <0 .0 5 ) ,SpO2 无显著变化 (P >0 .0 5 ) ;Ⅱ组MAP、HR、SpO2 均无显著性变化(P >0 .0 5 )。芬太尼用量Ⅰ组较Ⅱ组明显增多 (P <0 .0 5 )。结论 可乐定和氯胺酮联合用药不仅可以防治戒断反应 ,而且可以增强麻醉作用。术中要注意加强监护 。

Objective To study the anesthesia of druggers in abdomen surgery. Methods 108 patients were divided into two groups: groupⅠ ( n =92) were subjected to the intravenous injection of Droperidol 0.1 mg/kg+ 2.5% thiopental 5～6 mg/kg+Fentanyl 4 μg/kg+Scoline 2 mg/kg. After intubation, general anesthesia was maintained with 1%～2% Isoflurane and 1.6% Procain+ 0.1% Scoline and Fentanyl as required; group Ⅱ ( n =16) were taken orally Clonidine 5 μg/kg at 1 h before surgery. The patients were anesthetized with Ketamine 2 mg/kg+Scoline 2 mg/kg. After intubation, general anesthesia was maintained with 1%～2% Isoflurane and 1% Procain+ 0.1% Ketamine+ 0.1% Scoline. NIBP, ECG, SpO 2 and the Fentanyl dosage were continually monitored.Results Compared to the baseline, MAP and HR were increased evidently in groupⅠduring surgery as compared with that before operation ( P < 0.05 ), but there was no difference in group Ⅱ. The dosage of Fentanyl was used much more in groupⅠthan in group Ⅱ.Conclusion The combination of Clonidine and Ketamine can not only prevent the withdrawal symptom, but also make the effect of anesthesia stronger.