异丙酚、芬太尼、氯胺酮在上腹部手术应用的临床观察  

Balance Intravenous Anesthesia with Propofol、Fentanyl and Ket amine in Supra Abdomen Surgery

作　　者：曹殿青[1] 莫坚[1] 彭雪[1] 

机构地区：[1]广东医学院附属医院,广东湛江524001

出　　处：《实用医技杂志》2005年第03A期604-606,共3页Journal of Practical Medical Techniques

摘　　要：目的:观察异丙酚静脉平衡麻醉复合硬膜外神经阻滞在上腹部手术的临床效果,选择最佳的静脉配伍用药方案。方法:随机选择上腹部择期手术患者6 0例,随机分为3组:各组患者硬膜外麻醉平面确定后,给予异丙酚负荷剂量2 mg/ kg～3mg/ kg,待病人入睡后:D组单纯使用异丙酚,DF组使用异丙酚复合芬太尼,DFK组使用异丙酚复合芬太尼与氯胺酮持续泵入维持静脉麻醉。观察并记录患者术中基本生命体征、体动次数、单位时间用药量、术毕苏醒时间以及术后有无恶心呕吐、谵妄等不良反应及术后感受疼痛时间。结果:DFK组患者术中生命体征波动、患者体动次数、单位时间用药量明显小于D组(P<0 .0 5 ) ;各组患者苏醒时间、恶心呕吐、谵妄等方面差异无显著性;术后感知疼痛时间方面,D组明显早于DF组和DFK组。结论:异丙酚复合芬太尼、氯胺酮较单纯异丙酚或异丙酚复合芬太尼更适合于上腹部手术的静脉平衡麻醉,具有术中生命体征平稳、用药少。Objective To observe the clinical effe ct of balance intravenous anesthesia (IVA) with propofol, fentanyl and ketamine co mbined with epidural anesthesia (EA) in supra abdomen surgery.Methods Sixty ASA Ⅰ～Ⅱ pediatric patients undergoing elective supra abdominal surg ery were randomly divided into three groups: All the patients were undergoing EA combined with IVA. IVA was maintained with propofol in D group, propofol and fe ntanyl in DF group and propofol and fentanyl and ketamine in DFK group with a bo lus dosage of propofol (2 mg/kg^3 mg/kg).Results Variation of vita l signs,dosage per hour of propofol and times of movement during operation were lower in DFK group compared with that in D group (P<0.05).Patie nts in D group felt pain more earlier than those in DF or DFK group (P <0.05).There was no significant difference in recovery time,nausea vomiti ng and delusion between the three groups (P>0.05).Conclu sions Balance IVA with propofol,fentanyl and ketamine combined with EA in supra abdomen surgery is better than with propofol singly or propofol with fenta nyl, it has such advantages as stable vital signs during operation,low dosage a nd low expense.

关 键 词：平衡麻醉 异丙酚 芬太尼 氯胺酮 上腹部 

分 类 号：R614[医药卫生—麻醉学]