硫酸镁氯胺酮静脉麻醉与芬太尼静吸麻醉的比较研究

Study of Comparing Ketamine and Fentanyl in General Anesthesia

目的 比较硫酸镁氯胺酮静脉麻醉与芬太尼异氟醚静吸复合麻醉的优缺点，寻求一种麻醉效果优良，操作简单，副作用小，并发症少且费用低的麻醉方式。方法选择93例ASAⅠ-Ⅲ级需要全麻的病人，随机分为两组，硫酸镁氯胺酮组（观察组）60例，诱导：安定0．2-0．3mg／kg，阿曲库铵0．5-0．6mg／kg，氟哌利多5．0mg＋氯胺酮100mg＋利多卡因100mg稀释至20mL，0．3mL／kg。维持：氯胺酮200mg硫酸镁7500mg＋阿曲库铵25mg＋0．9％生理盐水200mL，静滴，调整滴速使心率维持在60-80次／min。芬太尼，异氟醚组（对照组）33例，诱导：安定0．1-0．2mg／kg，芬太尼0．02-0．04mg／kg，丙泊酚0．2-0．3mg／kg，阿曲库铵0．5-0．6mg／kg，维持吸入异氟醚，间断追加芬太尼阿曲库铵等维持同样心率，观察麻醉效果、苏醒情况，不良反应，并发症及用药费用等。结果两组麻醉效果无明显差异，拔管时时间有显著差异，用药费用有显著差异。结论硫酸镁能消除和预防氯胺酮心血管作用和精神症状，加强或保持氯胺酮的镇痛效果和延长阿曲库铵的肌松作用，两者合用即保证了麻醉效果，减少不良反应和并发症，费用低与芬太尼异氟醚静吸复合麻醉比较，有一定的优势。

Objective To find a good anesthesia method by comparing ketamine and fentanyl in general anesthesia. Methods 93 cases of ASA Ⅰ-Ⅲ patient were divided into two groups of ketamine group （study group 60 cases） and fentanyl group （control group 33 cases）. The observe group was treated with ketamine and the control group was given fenanyl and isoflurane inhaled. The HR, Anesthesia effect, recovery stauts, side effect, complication and payment were observed. Results There was no significant difference between two groups in effect but the extubative time and payment. Conclusion The magnesium sulfate might delete and prevent the cardiovascular action and mental action and also enhance and maintain the analgesia effect and prolong the effect of skelaxin. Both of them might be better than fentanyl with good effect, less side effect and complication and low payment.