小剂量氯胺酮复合咪达唑仑在失血性休克患者全麻诱导的应用

Application of small dose Ketamine combined with Midazolam to induction of genera anesthesia for patients with hemor- rhagic shock

目的探讨小剂量氯胺酮复合咪达唑仑用于失血性休克患者全麻诱导时的效果和安全性。方法选择失血性休克(代偿期)患者90例。采用数字表法随机分为KM、K、M三组,每组30例,诱导分别静注0.05mg/kg咪达唑仑+0.5 mg/kg氯胺酮(KM组)、0.5 mg/kg氯胺酮(K组)、0.05 mg/kg咪达唑仑(M组)。分别记录三组麻醉诱导前(T0)、诱导后(T1)、气管插管时(T2)的HR、SBP、DBP和术后24 h内发生精神症状及术中知晓的例数。结果与T0时点比较,T1、T2时点KM组和K组SBP、DBP稍有升高,HR稍有增快(P>0.05),M组SBP、DBP明显下降,HR明显增快(P<0.01);T1、T2时点KM组和K组SBP、DBP明显高于M组,HR明显慢于M组(P<0.01)。KM组和M组精神症状和术中知晓的发生率明显低于K组(P<0.05)。结论小剂量氯胺酮复合咪达唑仑应用于失血性休克患者全麻诱导,能有效地维持循环的相对稳定,增加麻醉的安全性。

Objective To investigate the efficacy of small dose Ketamine combined with Midazolam applied to induction of general anesthesia for the patients with hemorrhagic shock and its safety. Methods A total of 90 patients with decompensated hemorrhagic shock were divided into Group KM, K and M at random （n --30/group） according to digits table, which were treated intravenously with Ketamine （0.5 mg/kg） and Midazolam （0.05 mg/kg）, Ketamine （at the same dose as Group KM）, and Midazolam （at the same dose as Group KM）, respectively. The parameters, including heart rate （HR） , systolic blood pressure （SBP） and diastolic blood pressure （DBP） , were recorded down successively before induction of anesthesia （To ） , after induction （Tl ） and during en- dotracheal intubation （ T2 ） , as well as the number of the patients whose psychiatric symptoms occurred within 24 hours after surgery and whose awareness occurred intraoperatively. Results In Group KM and Group K, HR, SBP and DBP slightly increased at Tl and T2 , compared with at To （ P 〉 0.05 ）. In Group M, HR increased while SBP and DBP decreased significantly （ P 〈 0. O1 ）. At T1 and T2 , HR was significantly slower and SBP and DBP were significantly higher in Group KM and Group K than in Group M （ P 〈 0.01 ）. The incidences of psychiatric symptoms and intraoperative awareness of Group KM and Group M were significantly lower than that of Group K （ P 〈 O. 05 ）. Conclusion Small dose Ketamine combined with Midazolam used in the induction of general anesthesia for patients with hemorrhagic shock, can effectively maintain relatively stable circulation and greatly improve the safety of anesthesia.