阈下剂量氯胺酮用于失血性休克病人麻醉诱导对血压和心率的影响

Effect of subdissociative dose ketamine on blood pressure and heart rate of hemorrhagic shock patient during the induction of anesthesia

目的 探讨阈下剂量氯胺酮用于失血性休克病人全麻诱导时的临床效果。方法 失血性休克患者 4 8例 ,麻醉诱导均采用咪唑安定 0 .0 3mg/kg ,氯胺酮 (1.5mg/s的速度静注 ) ,芬太尼 4 μg/kg ,万可松 1mg/kg诱导插管。根据血压、氯胺酮用量不同分为 4组 :Ⅰ组 (SBP≥ 90mmHg) ,14例 ,氯胺酮 1mg/kg ;Ⅱ组 (SBP≥ 90mmHg) ,12例 ,氯胺酮 0 .5mg/kg ;Ⅲ组 (SBP <90mmHg) ,10例 ,氯胺酮 1mg/kg ;Ⅳ组 (SBP <90mmHg) ,12例 ,氯胺酮 0 .5mg/kg。监测并记录麻醉诱导前、给药后 3min的收缩压 (SBP)、舒张压 (DBP)、心率 (HR)。结果 4组病例患者年龄、性别、失血时间无显著差异 (P >0 .0 5 )。①BP :Ⅰ、Ⅱ、Ⅳ组患者应用氯胺酮后SBP均呈显著升高 (P <0 .0 5 ) ,分别增加达 2 0 %、15 %和 13% ,舒张压升高不显著 (P >0 .0 5 ) ;Ⅲ组患者应用氯胺酮后 ,SBP和DBP均呈显著下降(P <0 .0 5 ) ,分别减低 15 %和 10 %。②HR :Ⅰ、Ⅲ组HR增快显著 (P <0 .0 5 ) ,分别达 15 %和 2 5 % ,Ⅱ、Ⅳ组增快不显著 (P >0 .0 5 )。结论 阈下剂量氯胺酮用于失血性休克病人全麻时 ,可以获得满意的临床效果。

Objective To discuss clinical effect of subdissociative dose ketamine on hemorrhagic shock patients during the induction of anesthesia.Methods\ Midazolam(0.03 mg/kg),ketamine(infused at a rate of 1.5 mg/s) ,fentany(4 μg/kg) and vecuronium(1 mg/kg)were used during the induction of anaesthesia with the help of tracheal intubation.Forty eight patients were divided into four groups according to different blood pressures and doses of ketamine:group 1, 14 cases,(SBP≥90 mmHg),ketamine 1 mg/kg ; group 2,12 cases (SBP≥90 mmHg),ketamine 0.5 mg/kg; group 3, 10 cases (SBP<90 mmHg),ketamine 1 mg/kg and group 4, 12 cases (SBP<90 mmHg),ketamine 0.5 mg/kg.SBP,DBP,heart rates were monitored and recorded at preinduction,the time of three minutes after administration. Results\ Four groups had no statistical significance at age,sex, hemorrhagic time.The SBP in group 1,2 and 3 were dramatically increased (P<0.05), and reached 20%,15% and 13% respectively.The increase of DBP had no statistical significance(P>0.05). The SBP and DBP in group 3 decreased dramatically after injection of ketamine(P<0.05),decreased 15% and 10% respectively.Heart rates in group 1 and3 increased obviously(P<0.05),reached 15% and 25% respectively, and the changes in group 2 and group 4 were not significantly different(P>0.05).Conclusion\ Subdissociative dose ketamine for hemorrhagic shock patients under general anesthesia can have good clinical effect.