烧伤整形部位联合静脉麻醉对循环和应激的影响

Effects of combined regional-intravenous anesthesia on blood circulation and stress in burnt patients receiving plastic surgery

目的研究部位联合静脉麻醉对烧伤后整形患者循环和应激的影响.方法40例择期成年整形患者,ASAⅠ～Ⅱ级,随机分成两组.对照组（A组,n=20）采取全凭静脉麻醉,静脉输0.2%异丙酚溶液2～8 mg/（kg·h）、0.1%氯胺酮溶液1～4 mg/（kg·h）,间断静注氯胺酮注射液0.2～0.5 mg/kg、咪唑安定注射液0.02～0.05mg/kg、芬太尼注射液1～1.5μg/kg;实验组（B组,n=20）静脉麻醉用药同A组,另外采用部位麻醉方法.两组在麻醉前后适时监测循环指标和皮质醇（Cort）、去甲肾上腺素（NE）、肾上腺素（E）浓度.结果两组切皮后30min（T3）和切皮后1 h（T4）的平均动脉压、心率、Cort、NE、E等指标组间比较差异有统计学意义（P＜0.05或P＜0.01）.结论部位联合静脉麻醉用于成年烧伤整形患者,使其循环系统平稳,应激反应轻微,同时全麻用药量减小,术中、术后并发症少.

Objective To study the effects of combined regional - intravenous anesthesia on blood circulation and stress of burnt patients undergoing plactie surgery.Methods Forty adult patients, scheduled for selective plastic surgery, ASA grades Ⅰ～Ⅱ, were randomly divid- ed into two groups. Contrast group （group A, n= 20） and trial group （group B, n= 20） were given continuously propofol 2-8 mg/（kg·h） iv and ketamine 1 - 4 mg/（kg·h） iv, received intermittently ketamine 0.2- 0.5 mg/kg iv and midazolam 0.02- 0.05 mg/kg iv and fentanyl 1 - 1.5μg/kg. Group B underwent regional anesthesia at the same time. Circulatory system was monitored and serum concentrations of cortisone（Cort） ,norepinephrine（NE）, and epinephrine（E） were determined before and after anesthesia. Results Compared between the two groups at 30 min（T3） and lh（T4） after skin incision, the differences in the values of mean arterial presure and heart rate, in the concentrations of Cort,NE, and E were significant （ P 〈 0.05 or P 〈 0.01）.Conclusions Regional anesthesia combined with intravenous anesthesia can stabilize the circulatory system and reduce the stress response to the adult burnt patients undergoing plastic surgery after anesthesia. The required amount of general anesthetic is decreased. There are few comphcations during and after operation.