氯胺酮复合右美托咪啶在烧伤切痂植皮麻醉中的应用

Outcomes of ketamine-dexmedetomidine anesthesia in burn patients undergoing excision of eschar and dermoplasty

目的探讨氯胺酮复合右美托咪啶在烧伤切痂植皮术非气管插管麻醉中的效果。方法 60例择期切痂植皮手术患者,ASAⅠ-Ⅱ级,随机均分为氯胺酮复合右美托咪啶组(KD组)和氯胺酮复合丙泊酚组(KP组)。术中均保留自主呼吸,并用面罩给氧。记录心率、血压、脉搏血氧饱和度、心肌耗氧指数、氯胺酮用量、手术时间、苏醒时间、围术期镇静评分及出现的不良反应。结果与KP组相比,KD组右美托咪啶给药后10min收缩压增高(P<0.05),氯胺酮给药后5、10min降低(P<0.05),在氯胺酮给药后5、10、15min心率-收缩压乘积(RPP)降低(P<0.05),术后1h镇静评分增高(P<0.05),苏醒时间缩短(P<0.05)。结论烧伤切痂植皮术用氯胺酮复合右美托咪啶麻醉较复合丙泊酚能更好的维持血流动力学稳定,减少术中心肌氧耗,促进早期苏醒。

Objective To investigate the efficacy of ketamine-dexrnedetomidine anesthesia in burn patients undergoing excision of eschar and dermoplasty. Methods Sixty burn patients under,going excision of eschar and dermoplasty were equally randomized into two groups of KD （anesthetized with dexmedetomidine and ketamine） and KP （anesthetized with ketamine and propofol）. Spontaneous breathing and oxygen inhalation by mask were maintained during operation. HR, BP, SpO2, HR-systolie blood pressure （SBP） product （ RPP）, ketamine dosage, operation time, palinesthesia time, perioperative sedation score and side effects were recorded. Results Compared to group KP,in group KD, SBP was higher at 10 minutes after dexmedetomidine（P〈0. 05）, which was lower at 5 and 10 minutes after ketamine （P〈0. 05）. Compared to group KP,RPP was lower at 5,10 and 15 minutes after ketamine（P〈0. 05）, sedation score was higher at one hour after operation （P〈0.05） and awaking time was shorter in group KD（P〈0.05）. Conclusion Compared to ketamine-propofol anesthesia, ketamine-dexmedetomidine anesthesia can keep more stable hemodynamics, reduce intraoperative RPP and promote palinesthesia in burn patients undergoing excision of eschar and dermoplasty.