瑞芬太尼复合小剂量氯胺酮对自主神经调控的临床研究  

Clinical Research of Remifentanil Combined with Small Doses of Ketamine to Autonomic Nervous Regulation

作　　者：王文波[1] 于秀艳[1] 郭忠宝[1] 

机构地区：[1]黑龙江省齐齐哈尔市第一医院麻醉科,黑龙江齐齐哈尔161005

出　　处：《世界最新医学信息文摘》2012年第8期11-12,共2页World Latest Medicine Information Electronic Version

摘　　要：目的探讨瑞芬太尼复合小剂量氯胺酮对甲状腺手术病人颈丛阻滞后自主神经调控的安全性。方法选择ASAⅠ-Ⅱ级择期行甲状腺手术病人120例，随机分为实验组和对照组，每组60例，病人入手术室后均给予咪唑安定40μg/kg，试验组给予瑞芬太尼1mg＋氯胺酮100mg微泵榆注，泵速0．04-0．12μg／kg／min；对照组泵注生理盐水。随后进行颈丛阻滞。观察指标：镇痛、镇静评分；记录麻醉前、颈丛阻滞后、处理甲状腺上极、切除腺体时、手术结束时MAP、HR、SpO2、RR及不良反应。结果试验组VAS评分明显低于对照组（P〈0．05）；试验组镇静满意（P〈0．05）；试验组血流动力学变化相对稳定。结论瑞芬太尼复合小剂量氯胺酮可以有效抑制甲状腺手术病人颈丛阻滞后交感神经兴奋性。Objective To explore the safety for the autonomic nervous regulation after remifentanil combined with small doses ofketamine on thyroid surgery patients with cervical plexus block. Methods 120 ASA Ⅰ-ⅡI patients aged 28- 58 yr weighing 41 - 76kg.The patients were randomly divided into experimental group （ R ） and the control group （ D ）, each of 60 cases. In the operating room, the patients were given midazolam 40μg/kg, group R was given the mixture （ remifen- tanil Img ＋ ketamine 100rag diluted to 50 ml ） through micro pump infusion, The speed was 0.04 μg/kg/min - 0.12μg/ kg/min, group D pumped normal saline. Followed underwent cervical plexus block. Oberservation index ： analgesia（ VAS ） scores, sedation （ Ramsay ） scores, MAP, HR, SpO2, RR were recorded before anesthesia, after cervical plexus block, deal with thyroid upper pole, resection of the thyroid gland, the end of surgery, and recorded adverse effects. Results VAS scores of remifentanil group were significantly lower than those of the control group （ P〈0.05 ）, sedation satisfied in group R （ P〈0.05 ）, and hemodynamic changes were relatively stable. Conclusion Remifentanil combined with small doses of ketamine can effectively inhibit the sympathetic nerve in the thyroid surgery patients with cervical plexus block.

关 键 词：瑞芬太尼 氯胺酮 自主神经 

分 类 号：R581[医药卫生—内分泌]