阈下剂量氯胺酮复合硬膜外麻醉用于外伤性脾破裂手术的临床观察

Clinical Observation of the Operation for Patients with Ruptured Spleen Under Epidural Space Anesthesia Combined with Under Threshold Dose of Ketamine

目的：观察阈下剂量氯胺酮复合硬膜外麻醉对失血性休克代偿期的血流动力学影响。方法：硬膜外麻醉下３６例无失血性休克表现的外伤性脾破裂，异丙嗪０．５ｍｇｋｇ－１，哌替啶１ｍｇｋｇ－１静脉滴注后随机分成２组，Ⅰ组（ｎ＝１７），切皮前氨胺酮０．５ｍｇｋｇ－１静脉滴注；Ⅱ组（ｎ＝１９），不加氯胺酮进行对照。连续监测麻醉前后ＳＢＰ、ＤＢＰ、ＭＡＰ、ＨＲ、ＳＰＯ２、ＥＣＧ。结果：Ⅱ组ＳＢＰ、ＤＢＰ、ＭＡＰ下降显著（Ｐ＜０．０１），ＨＲ代偿性增加（Ｐ＜０．０５）。Ⅰ组ＢＰ、ＨＲ变化不大。组间对照，术中ＢＰ两组差异性极显著（Ｐ＜０．０１），ＨＲ无差异性（Ｐ＞０．０５）。结论：提示阈下氯胺酮复合硬膜外麻醉能产生较稳定的血流动力学效应，可用于休克代偿期的病人。

Objective:To observe the effects of epidural anesthesia combined with under-threshold ketamine on the hemodynamics of the compensatory stage of bleeding shock for operations of patients with traumatic ruptured spleen Method:36 cases of patients with traumatic ruptured spleens without manifestations of bleeding shocks were given epidural anesthesia:after iv dropping of pethidine 1mg kg -1 and phenergan 0.5 mg kg -1 the patients were randomly divided into two groups:group I( n =17) being given iv dropping of ketamine,0.5mg kg -1 prior to the operation and group Ⅱ( n =19)without ketamine as controes the SBP、DSP、MAP、HR、SPO 2 and ECG were successively monitored both before and after the operations.Results:During the operations the BP of the two grours showed signficant difference( P <0.01)while the HR didn′t( P >0.05);the SBP、DBP and MAP in group Ⅱ dropped markedly and the HR showed compensatory increase( P <0.05) while the BP and HR in group I showed slight fluctuations.Conclusion:It is suggested that the epidural anesthesia combined with ketamine for patients with traumatic ruptured spleens can produce comparatively stable hemodynamic effects,suitable for patients with compensatory bleeding shocks