异丙酚复合瑞芬太尼气管插管与复合氯胺酮非气管插管麻醉在烧伤手术中的比较.doc

异丙酚复合瑞芬太尼气管插管与复合氯胺酮非气管插管麻醉
在烧伤手术中的比较
张学康
南昌大学第一附属医院麻醉科 330006 江西南昌
[摘要] 目的比较异丙酚复合瑞芬太尼气管插管与复合氯胺酮非气管插管麻醉在烧伤手术中的特点。方法 60例择期烧伤手术病人,ASAⅠ-Ⅱ级,随机分为A、B两组,每组30例,A组为氯胺酮组, 麻醉诱导用安定和氯胺酮,维持麻醉用微量泵持续输注异丙酚和氯胺酮,术中保留自主呼吸并用鼻导管给氧;B组为瑞芬太尼组,麻醉维持用咪唑安定、阿曲库铵、丙泊酚、瑞芬太尼,气管插管后机械通气,,维持麻醉用微量泵持续输注瑞芬太尼、丙泊酚、阿曲库铵。观察麻醉前、麻醉诱导后、手术开始时、术中45 min、术毕5 min各时点的MAP、HR和SpO2的变化以及术后苏醒时间和术中术毕时出现的不良反应。结果麻醉诱导后A组的MAP明显增高,而B组的MAP显著下降,两组比较,差异也有统计学意义P<);麻醉诱导后A组的SpO2明显下降,而B组的SpO2在比麻醉前高;B组病人苏醒时间明显比A组短P<);A组术中易发生躁动、谵妄和呼吸抑制等不良反应。结论异丙酚复合瑞芬太尼气管插管麻醉用于烧伤手术,呼吸循环稳定,苏醒及时,不良反应少,提高了麻醉的安全性,且便于麻醉管理,是一种更值得提倡的麻醉方法。
[关键词] 异丙酚;瑞芬太尼;氯胺酮;气管插管;烧伤麻醉
Comparison of propofol and remifentanil with tracheal intubation and propofol and ketamine without tracheal intubation in burn surgery. ZHANG Xue-kang. Department of Anesthesiology, the First Affiliated Hospital of Nanchang University, Nanchang 330006 CHINA
[Abstract] Objective pare the characteristics of propofol and remifentanil with tracheal intubation and propofol and ketamine without tracheal intubation in burn surgery. Methods sixty ASAⅠorⅡpatients undergoing elective burn surgery were randomized into 2 groups (n=30): ketamine group (A) and remifentanil group (B). Anesthesia was induced with diazepam and ketamine, and was maintained with pumping-in of propofol and ketamine, without tracheal intubation in group A; Anesthesia was induced with midazolam, atracurium besilate, propofol, and remif