丙泊酚、氯胺酮全凭静脉麻醉应用于烧伤病人的临床研究

A CLINICAL STUDY OF PROPOFOL COMBINED WITH KETAMINE UNDER PATIENTS UNDERGOING BURNT SURGERY IN TOTAL INTRAVENOUS ANESTHESIA

目的:研究微量注射泵输注丙泊酚和氯胺酮全凭静脉麻醉在烧伤患者切痂植皮手术中的临床效果。方法:选择期手术患者,随机分为丙泊酚、氯胺酮组(P·K组)和咪达唑仑、氯胺酮组(M·K组)。P·K组术前10min首次静注丙泊酚2mg·kg和氯胺酮2mg·kg。M·K组术前10min首次静注咪达唑仑0 2mg·kg、氯胺酮2mg·kg ,随后两组以微量注射泵输注控制在P·K组丙泊酚6 6 . 6 6 μg·kg-1·min-1和氯胺酮4 1 .6 6 μg·Kg-1·min-1。记录注药后5、10min、切痂、取皮、植皮及停药后5、10min各时段无创血压(MAP)心率(HR)脉搏氧饱和度(SpO2 )及两组氯胺酮用药量变化。结果:P·K组氯胺酮用药量比M·K组少,P·K组MAP和HR无明显变化(P >0 . 0 5 ) ,M·K组MAP、HR均较麻醉前升高(P <0 . 0 1) ,两组SpO2 于诱导注药后均有一过性下降,数分钟恢复正常,两组比较差异无显著意义(P >0 . 0 5 )。结论:微量注射泵输注丙泊酚和氯胺酮全凭静脉麻醉安全可行,副作用小,可控性强,适用于烧伤患者切痂植皮手术。

Objective:To study the effects of propofol combined with ketamine under patients undergoing burnt surgery in total intravenous anesthesia administered by continuous infusion in intravenous general anesthasiaMethods:Forty ASAⅠ～Ⅱpatients undergoing elective burnt surgery under total intravenous anesthasia were randomly divided into two groups:group P·K(propofol + ketamine ) and group M·K (midazolam + ketamine)In group P·K after propofol(2 mg·kg -1) and ketamine (2 mg·kg -1) had been injected 10 min before operation the patients received propofol(6666 ug·kg -1·min -1) and ketamine(4166 ug·kg -1·min -1) continuous intravenous infusionIn group M·K after midazolam (02 mg·kg -1) and ketamine (2 mg·kg -1) had been injected 10 min before operation the patients received propofol(6666 ug·kg -1·min -1) and ketamine(4166 ug·kg -1·min -1) continuous intravenous infusionIn the two groups the rate of infusion was determined by depth of the patients anesthesia,and Mean arterial press (MAP),heart rate (HR) and degree of puls oxygen (SpO 2) were measured at 5 min and 10 min after anesthesia begin,incising scar,drawing skin,transplanting skin,at 5 min and 10 min after anesthesiaThe amount of ketamine in the two group was calculatedResults:The change of MAP and HR wasn't significant in group P·K(P>005) , nevertheless it was striking in group M·K(P<001)SpO 2 decreased transiently and it raised quickly to the normal standard,it was not significantly different between the two groups (P>005) The amount of ketamine in group P·K was less than in group M·KConclusions:The effects of propofol combined with ketamine under patients undergoing burnt surgery in total intravenous anesthesia was good , this method was feasible and safe Its disadvantageous influence was little and it could be controlled easily This method fit for the operation of under burnt surgery