异丙酚及氯胺酮靶控输注全静脉麻醉临床应用  

Clinical study on target-controlled infusion of propofol for TIVA with ketamine as analgesia

作　　者：张兴安[1] 吴群林[1] 施冲[1] 徐波[1] 戴永忠[1] 

机构地区：[1]广州军区广州总医院麻醉科,广州510010

出　　处：《广东医学》2003年第1期27-29,共3页Guangdong Medical Journal

基　　金：广东省自然科学基金资助项目 (编号 :2 0 0 2C40 4 0 1 );军队科研基金资助项目 (编号 :2 0 0 1B1 4 )

摘　　要：目的　研究异丙酚复合不同镇痛剂量氯胺酮靶控输注全静脉麻醉临床应用的可行性及对血流动力学、麻醉恢复的影响。方法　择期手术患者 80例 ,分别采用异丙酚 (P组 ,n =16)及复合氯胺酮血药浓度 0 2 0mg/L(PK1组 ,n =16) ,0 40mg/L(PK2 组 ,n =16) ,0 60mg/L(PK3 组 ,n =16)和 0 80mg/L(PK4组 ,n =16)全静脉麻醉 ,采用微机控制Graseby 3 5 0 0输液泵靶控输注异丙酚或氯胺酮 ,连接Aspect-A10 0 0型脑电监护仪监测脑电变化 ,观察两组患者血流动力学改变及麻醉恢复情况。结果　单用异丙酚患者随着异丙酚血药浓度升高脑电双频指数 (BIS)值降低 ,呈明显负相关 (P <0 0 5 ) ,氯胺酮血药浓度从 0 2 0mg/L增至 0 80mg/L ,BIS值无明显变化 (P >0 0 5 )。与P组相比 ,PK1,PK2 ,PK3 ,PK4组异丙酚用量减少约 15 %～ 40 % ,PK4组停药至睁眼时间明显延长 ,其余各组无明显差异 (P >0 0 5 )。术中P ,PK1组收缩压、舒张压升高 ,PK2 ,PK3 ,PK4组无明显改变。术后无躁动、不良回忆等并发症。结论　异丙酚复合镇痛剂量的氯胺酮 (0 40～ 0 60mg/L)靶控输注全静脉麻醉具有血流动力学稳定、减少异丙酚用量、无明显术后并发症等优点。Objective To study the feasibility of target controlled infusion of propofol for TIVA with ketamine as analgesia, the influence of hemodynamics and recovery of anaesthesia. Methods Eighty patients scheduled for elective surgery were selected for target controlled infusion of propofol(group P)or propofol with ketamine as analgesia for TIVA while EEG was recorded. The plasma concentration of ketamine was 0 20 mg/L (group PK 1, n =16), 0 40 mg/L (group PK 1, n =16), 0 60 mg/L(group PK 1, n =16) and 0 80 mg/L(group PK 4, n =16). The hemodynamic changes and recovery of anesthesia in all patients were observed. Results The plasma propofol concentration correlated with bispectral index(BIS) negatively. There was no correlation between ketamine and BIS while plasma ketamine concentration increased from 0 20 mg/L to 0 80 mg/L. The dosages of propofol in group PK 1, PK 2, PK 3 and PK 4 were reduced by nearly 15%～40% in comparsion with group P. The period from the end of infusion to opening eyes was longer in group PK 4 than in group P( P <0 05). Systolic and diastolic blood pressure in group P and group PK 1 significantly increased, and no changes were found in group PK 2, PK 3 and PK 4. Conclusion Target controlled infusion of propofol with ketamine as analgesia(0 40～0 60 mg/L)for TIVA has the advantages of hemodynamic stability, reduced dosage of propofol and no complications of anesthsia.

关 键 词：静脉麻醉 临床应用 异丙酚 氯胺酮 鞍控输注 TCI 

分 类 号：R614.24[医药卫生—麻醉学] R971.2[医药卫生—外科学]