瑞芬太尼、异丙酚联合小剂量氯胺酮静脉麻醉在乳腺手术中的应用

目的探讨瑞芬太尼、异丙酚联合小剂量氯胺酮全凭静脉麻醉在乳腺手术的应用。方法80例ASAⅠ～Ⅱ级择期乳腺手术病人，随机分成实验组（Ⅰ组）和对照组（Ⅱ组），各加例，均选择全凭静脉麻醉。病人入手术室后常规面罩吸氧（4L／min）。1组手术开始前10min，泵注异丙酚80μg·kg^-1·min^-1、瑞芬太尼0．1μg·kg^-1·min^-1，术前1min追加氯胺酮0．4mg·kg^-1，术中根据情况调整瑞芬太尼泵注速度为0．05—0．1μg·kg^-1·min^-1，术中酌情追加氯胺酮，术毕停止泵注瑞芬太尼、异丙酚。Ⅱ组手术开始前10min泵注异丙酚80μg·kg^-1·min^-1，术前1min追加氯胺酮1mg·kg^-1，术中酌情追加氯胺酮，术毕停止泵注异丙酚。结果两组病人术中均安静入睡，镇痛完善，无躁动，无胸壁强直等现象。Ⅱ组发生轻度呼吸抑制1例、高血压9例、术毕苏醒期躁动8例及精神障碍3例，其中高血压、苏醒期躁动发生率比Ⅰ组增高明显（P〈0．05）；术中MAP与术前相比增高明显（P〈0．05），而Ⅱ组与Ⅰ组相比增高又显明显（P〈0．05）。Ⅰ组发生轻度呼吸抑制2例、苏醒期躁动1例，氯胺酮用量与Ⅱ组相比明显减少（P〈0．05）；术毕苏醒时间与Ⅱ组相比明显缩短（P〈0.05）。结论瑞芬太尼、异阿酚联合小剂量氯胺酮全凭静脉麻醉用于乳腺手术是一种较好的联合用药方法。

Objective To investigate the use of intravenous anaesthesia induced with combination of remifentanil, propofol and low dose ketamine in galactophore operations. Methods Eighty ASA Ⅰ-Ⅱ elective galactophore operations undergoing intravenous anaesthesia with no trachea intubatton were randomly divided into two groups： study group （ group Ⅰ, n = 40 ） and control group（ group Ⅱ, n = 40）. It was a routine that inhaling oxygen with veil（4L/min） after patients enter the operating room. In group Ⅰ, remifentanil （0.1μg/kg, min） and propofol （80μg/kg,min） were pumped at 10 minutes before operation. Ketamine （ 0.4 mg/kg,min） was added before operation and low dose ketamine if need during the operation. In group Ⅱ, Only prepofol （80μg/kg. min ） was pumped at 10 minutes before operation. Ketamine（1mg/kg, min ）was added before operation and low dose ketamine if need during the operation. Results All patients in two group fell asleep calmly and no pain,no fidget,no chest wall rigidity was happened during the operation, in group Ⅱ, slight respiratory depression was found in one case,were found hypertension in 9 cases： fidget in 8 cases and spirit abnormity in 3 cases . In operation, MAP in group Ⅱ was significantly increased than that in group Ⅰ and before operation（p 〈 0.05）. In group Ⅰ , slight respiratory depression was found in 2 cases in operation and fidget after operation in lcase. The time of come around after operation was significantly shorter in group Ⅰ than that in group Ⅱ（p 〈 0.05）. The dose of ketamine used in group Ⅱwas significantly more than that in group Ⅰ（p 〈 0.05 ）. Conclusion It is a good method of united medication with intravenous anaesthesia induced with combination of remifentanil,propofol and low dose of ketamine in galactophore operations.