右美托咪定复合氯胺酮全麻运用于烧伤患者削痂植皮术的可行性  

The feasibility of the combination of dexmedetomidin and ketamine for patients with burn undergoning escharotomy and skin grafting

作　　者：朱志鹏[1] 周红梅[1] 张才军[1] 于鹏[1] 

机构地区：[1]浙江省嘉兴学院附属第二医院麻醉科,314000

出　　处：《中华全科医学》2014年第3期362-364,共3页Chinese Journal of General Practice

基　　金：嘉兴市科技局(2011AY1049-2)

摘　　要：目的探讨右美托咪定复合氯胺酮静脉全麻用于烧伤患者削痂植皮术的可行性。方法择期拟行切痂植皮术的体表烧伤患者30例，ASA分级Ⅱ或Ⅲ级，性别不限，年龄25～55岁，体重45—80kg。随机数字表法分为2组（n=15）：氯胺酮-异丙酚组（KP组）和氯胺酮-右美托咪定组（KD组）。2组分别以氯胺酮32ug／（kg·min）复合异丙酚120ug/（kg·min）或右美托咪啶0．1ug／（kg·min）诱导，BIS值≤60时再以氯胺酮16ug／（k·min）分别复合异丙酚0～60ug／（kg·min）和右美托咪啶0～0．03ug／（kg·min）维持麻醉，术中维持BIS值40—60。分别于麻醉前、BIS值≤60时、切痂、取皮、植皮、手术结束等不同时间点观察血压、心率、PaO2、PaCO2值。记录睁眼时间、定向力恢复时间、Ramsay镇静评分以及并发症发生率。结果与KD组比较，KP组血压明显下降，PaCO2明显升高，PaO2明显降低；而KD组诱导后HR短暂升高，呼之睁眼时间、定向力恢复时间明显缩短（P〈0．05）。结论右美托咪定复合氯胺酮对削痂植皮术患者能够提供良好的循环、呼吸支持，且复苏效果好。Objective To explore the feasibility of the combination of dexmedetomidine（dex）and ketamine during escharotomy and skin grafting for patients with burn undergoning escharotomy and skin grafting. Methods Thirty patients, ASA II or III, male or female, aged 25 - 55 years, weighed 45 - 80 kg, scheduled for elective surgery were randomly assigned into 2 groups（ n = 15 each） ： ketamine-propofol group（KP） and ketamine-dex group（kD）. All were induced by 32 ug/kg/ min ketamine with 120 ug/kg/min propofol or 0.1 ug/kg/min dex respectively,maintained with 16 ug/kg/min ketamine with 0 - 60 ug/kg/min propofol or 0 - 0.03 ug/kg/min dex. MAP, HR, PaO2 and PaCO2 were observed perioperatively. Recovery parameter was recorded. Results Compared with group KD, the MAP and PaO2 decreased significantly in group KP, PaCO2 incresed. HR in the group KD increased transiently. The time of eye opening and orientation recovery time were significantly shorter in KD group. Conclusion The combination of dex and ketamine for patients with burn can provide good circulation, respiratory support, and better recovery, which can be safe and effective.

关 键 词：右美托咪啶 氯胺酮 烧伤 切痂植皮术 

分 类 号：R614.2[医药卫生—麻醉学] R622.1[医药卫生—外科学]