两种不同麻醉方法在锁骨骨折手术中的比较  

A Comparative Study on two Different Anaesthetic Techniques During for Operation on Fracture of Clavicle

作　　者：陈信发[1] 郑妈迎[1] 

机构地区：[1]汕头市中心医院,广东汕头515041

出　　处：《实用医技杂志》2005年第04B期1029-1030,共2页Journal of Practical Medical Techniques

摘　　要：目的:探讨两种不同麻醉方法在锁骨骨折手术中的应用,观察比较它们的麻醉效果及其并发症。方法:12 0例锁骨骨折病人,随机分成两组:丙泊酚-氯胺酮全身麻醉组(PK组) ,n =6 0 ;罗哌卡因神经阻滞组(RO组) ,n =6 0。PK组:丙泊酚-氯胺酮以质量比2∶1配成混合液(PK液) ,切皮前,先给予丙泊酚1.5mg/kg ,缓慢静脉注射,5min后给予氯胺酮1.5mg/kg ,缓慢静脉注射进行麻醉诱导,术中按丙泊酚剂量以每小时4mg/kg～8mg/kg微泵输注PK复合液,按需调整给药速度。RO组:①先行斜角肌间臂丛阻滞:注入0 .33%罗哌卡因15ml～2 0ml;②再行颈深、浅神经丛阻滞:分别注入0 .33%罗哌卡因4ml和5ml。结果:PK组麻醉效果优为6 0例(占10 0 % ) ,术中血压、心率平稳,动脉血氧饱和度(SpO2 )均在94 %以上,术中无呕吐及呼吸抑制等情况。RO组:麻醉效果优为5 1例(占85% ) ,良为9例(占15 % ) ,出现局麻药毒性反应1例,喉返神经阻滞3例,术中出现血压升高7例、心率加快7例,SpO2均在94 %以上,术中无呕吐。PK组麻醉效果优于RO组。结论:PK组用于锁骨骨折手术的麻醉效果优于RO组,副作用少。丙泊酚复合氯胺酮全身麻醉用于锁骨骨折手术是一种安全、简便,麻醉效果佳的麻醉方法。Objective To investigate the applicati on s of 2 different anaesthetic techniques for operation on fracture of clavicle, o bserving and comparing their anaesthetic effects and their complications. Methods 120 patients suffering fracture of clavicle were divided into 2 groups random: general anaesthesia with propofol-ketamine (PK group ), n=60;nerve block with ropivacaine (RO group),n=60.PK group: Mixing propofol-ketamine into mixture of PK according to ratio of quality 2:1.G eneral anaesthetic was induced with propofol 1.5 mg/kg intravenously in slow rat e,5 min utes later, infusing ketamine 1.5 mg/kg intravenously in slow rate, the mixture of PK was infused at a ratio of 4 mg/(kg·h)～8 mg/(kg·h) according to the dose of propofol during the operation, adjusting the infusion rate according to the need, 10 minutes before the end of operation, stop infusing the mixture of PK.RO group ①interscalene brachial plexus block: injecting 0.33 % ropivacain e 15～20 ml.②Patients received one-needle's deep and superficial cervical plex us block with 0.33 % ropivacaine 4 ml and 5 ml.Results PK group Th e anaesthetic effects were excellent of all these 60 cases (100 %),their BP and HR were stable during the operations,the SpO2 were more than 94 %,there were no cases with vomit or respiratory depression.RO group:The excellent anaesthetic ef fects were 51 cases only (85 %), the good anaesthetic effects were 9 cases (15 % ), 1 case appears the toxic responses of local anesthetics, 3 cases were found r ecurrent laryngeal nerve block, 7 cases were found BP and HR increasing, the SpO 2 were more than 94 %, there were no cases with vomit.The effect of general an aesthesia with propofol-ketamine was better than nerve block with ropivacaine. Conclusion The effect of general anaesthesia with propofol-ketami ne (PK group ) for operation on fracture of clavicle is better than nerve block with ropivacaine ( RO group ), there is few side-effect. The general anaesthes i a with propofol-ketamine for operation on fracture o

关 键 词：锁骨手术 全身麻醉 神经阻滞 

分 类 号：R614[医药卫生—麻醉学]