地震伤后不同时段丙泊酚复合瑞芬太尼或氯胺酮微泵法行静脉全麻的临床观察

Clinical observation remifentanil or ketamine combined with propofol infusion under total intravenous anesthesia in patients injured in the massive earthquake at different times

目的探讨地震伤后不同时段丙泊酚复合瑞芬太尼或氯胺酮微泵法行非插管静脉全麻的效果及其对患者呼吸、循环和苏醒时间的影响。方法60例地震致伤手术患者,Ⅰa和Ⅰb组各15例为伤后12h内接受麻醉,Ⅱa和Ⅱb组各15例为伤后48～72h接受麻醉。Ⅰa和Ⅱa组均为丙泊酚-瑞芬太尼合剂,Ⅰb和Ⅱb组均为丙泊酚-氯胺酮合剂。观察记录4组患者麻醉中的血流动力学,记录停药至苏醒的时间,苏醒质量及麻醉效果(由术者评价)。结果4组术中镇痛均完善,Ⅰa和Ⅱa组患者安静,分泌物少,停药后5～10min苏醒;MAP、HR在T1、T2、T3时点有不同程度的下降,Ⅱa组下降之幅度明显>Ⅰa组(P<0.05)。Ⅰb和Ⅱb组患者基本安静,分泌物较多,停药后10～30min苏醒;MAP、HR有不同程度的上升(P>0.05)。4组RR、SpO2无明显变化,苏醒质量差异亦无统计学意义。结论丙泊酚复合瑞芬太尼或氯胺酮微泵法行静脉全麻给药恒速且用量少、镇静、镇痛完善,对循环的影响于地震前段轻微,伤后较长时间则前者影响较大;丙泊酚复合瑞芬太尼可控性强、苏醒快且彻底,而丙泊酚复合氯胺酮循环更稳定,两者应用于地震伤后患者的麻醉应区分伤后时段性,加强呼吸、循环的管理。

Objective To investigate the effect of remifentanil or ketamine combined with propofol infusion under total in- travenous anesthesia at different times of the earthquake. Methods Sixty debridement operation patients were divided into four groups（n=lS）, I a and I b groups received anesthesia in 12 hours after the earthquake occurs, I1 a and lib groups received anesthesia between 48 and 72 hours after the earthquake occurs. I a and II a groups used compounds of propofol and remifen- tanil, I b and I1 b groups used compounds of propofol and ketamine, All the drugs were injected intravenously with micro-pump. Variation of circulation and breath and awaken time after operation were observed and sedative and analgesic effect during opera- tion were evaluated. Results The anesthesia efficacy of study groups was similar to that of control groups, but bemodynamie pa- rameters decreased sharply in study group than those in control group（P〈0.05 ） in patients who received anesthesia between 48 and 72 hours after the earthquake occurs. A better recovery and less side effects were found in study groups than those in control groups. Conclusion Total intravenous anesthesia with propofol combined with remifentanil or ketamine has such advantage as low dosage,little influence on circulation and breath and short awaken time in 12 hours after the earthquake occurs ,but the influ- ence on circulation of the former was biger than that of the latter in patients who received anesthesia between 48 and 72 hours after the earthquake occurs. So we must differentiate the period after injure when we chose the two ways.