微泵静注氯胺酮-丙泊酚在烧伤微粒植皮手术中的效果

Effect of Micro-Pump Intravenous Ketamine-Propofol in the Operation of Burn Particle Skin Grafting

目的:探讨氯胺酮复合丙泊酚微泵静脉麻醉用于烧伤微粒植皮手术的麻醉效果。方法:选择择期行微粒植皮手术的特重度烧伤患者42例,ASAⅡ～Ⅲ级,烧伤总面积52%～75%TBSA,手术切痂面积20%～35%TBSA。随机分为2组,一组采用氯胺酮与咪达唑仑分次静脉给药(KM组),另一组采用氯胺酮复合丙泊酚微泵持续静脉给药(KP组),术中观察并记录不同时间点血流动力学变化、手术时间、术毕苏醒时间、氯胺酮总用量及术中、术后不良反应。结果:组内比较,KP组术中T1～6时的MAP,HR,SPO2与T0时比较差异无统计学意义(P>0.05)。KM组T1～6时的MAP,HR与T0时相比升高(P<0.05);术中T1～6时的SPO2与T0时比较差异无统计学意义(P>0.05)。组间比较,KP组在T1,T4,T5,T6时MAP与KM组相比降低(P<0.05);KP组在T2,T3,T4,T5时HR与KM组相比减慢(P<0.05)。术中氯胺酮用量、术毕至苏醒时间KP组比KM组用量少,时间短,差异有统计学意义(P<0.05)。KM组术中不自主肢体运动、术后嗜睡、梦幻现象与KP组比较差异有统计学意义(P<0.05)。结论:氯胺酮复合丙泊酚微泵静脉麻醉用于烧伤微粒植皮手术的效果优于氯胺酮与咪达唑仑分次静脉麻醉。

Objective：To investigate the anesthesia effect of Ketamine and Propofol with micro-pump intravenous anesthesia for the operation of burn particle skin grafting.Methods： Forty-two patients with extremely severe burn,who was undergoing the selective particle skin grafting with ASA II-III level,whose total burn areas were 52%-75% TBSA,surgical excision areas were 20%-35% TBSA,were randomly divided into two groups.One group received fractionated intravenous injection of Ketamine and Midazolam（KM group）,the other group was injected with Ketamine and Propofol by micro-pump continuous intravenous administration（KP group）.They would be observed and recorded intraoperative hemodynamic changes of different time points,operation time,recovery time of finished surgery,the total amount of Ketamine and the intraoperative and postoperative adverse effects.Results： Comparing the MAP,HR and SPO2 of intra-operative T1-6 in KP group and those of T0,there was no significant difference between the T1-6 and T0（P0.05）.The MAP and HR of T1-6 in KM group increased when comparing with those of T0（P0.05）.Comparing the SPO2 of intra-operative T1-6 and that of T0,there was no significant difference between the T1-6 and T0（P0.05）.MAP decreased at T1,T4,T5 and T6 time points in KP group comparing with that of KM group（P0.05）.When the KP group was at T2,T3,T4 and T5,HR was lower than that of KM group（P0.05）.The intraoperative amount of Ketamine,recovery time of surgery of the KP group were fewer and the time was shorter than those of the KM group.There was significant diffe-rence（P0.05）.Comparing the intraoperative involuntary limb movements,postoperative drowsiness,dream pheno-mena in KM group with those of KP group,there was significantly different（P0.05）.Conclusion： The effect that Ketamine and Propofol micro-pump intravenous anesthesia is used to treat the burn particle skin grafting is superior to the fractionated intravenous anesthesia of Ketamine and Midazolam.