小剂量氯胺酮预防全身麻醉下止血带不良反应的发生

Preadministration of Low-dose Ketamine Reduces Tourniquet-induced Adverse Effects in Orthopedic Patients Under General Anesthesia

目的：观察小剂量氯胺酮预防下肢手术时止血带充气期所致不良反应的临床效果。方法：下肢手术的患者30例（ASAⅠ-Ⅱ级），随机分为两组，每组15例。两组均在全身麻醉下手术，组1在止血带充气前15min静脉注射氯胺酮0．1mg／kg，组2为空白对照组，记录止血带充气前、手术开始切皮时、止血带充气后30min、止血带充气后60min四个时间段的MAP（Meanartery pressure，平均动脉压）和HR（Heart rate，心率）。结果：两组手术开始切皮后MAP和HR较止血带充气前均无统计学差异，但组2在止血带充气后30rain和60min的MAP和HR均比充气前显著升高，加深麻醉亦不能奏效，必须加用血管活性药物，甚至停止止血带使用。结论：小剂量氯胺酮预防下肢手术时止血带充气所致的血压升高和心率增快，安全有效，无不良副作用。

Objective： In this study, we assesses the effects of preadministration of low-dose ketamin on blood pressure and heart rate during tourniquet inflation under general anesthesia. Methods： Thirty patients of ASA class Ⅰ or Ⅱ, scheduled for lower limb surgery, were randomly divided into two groups. In group 1 underwent general anesthesia with preadministration of low-dose ketamine 0. lmg/kg, and in group 2 also underwent general anesthesia with the same volume of saline. The changes of MAP and HR were measured before tourniquet inflation, after skin incision, 30min and 60rain after inflation. Results：Comparing group 2 with group 1, there were significant increases before tour- niquet inflation to 30min and 60min after inflation in MAP and HR in group 2 （P〈0. 05）. What is more, all of the pa- tients have tachycardia in group 2 on 60min after inflatioru Conelusion~ The results demonstrate that patients who re- ceived preadministration of low-dose ketamin showed less increase in MAP and HR during tourniquet inflation. KEY WORDS Ketamine, General anesthesia, Limb surgery, Tourniquet, Precaution