静注氯胺酮-硝酸甘油复合异氟醚低流量循环紧闭麻醉的应用  

Intravenous low-dose Ketamine-Nitroglycerin added to the low-flow closed circuit anesthesia with isoflurane

作　　者：袁孝忠[1] 黄兵[1] 孙建良[1] 周煦燕[1] 张运龙[1] 陆雅萍[1] 

机构地区：[1]浙江省嘉兴市第一医院麻醉科,314000

出　　处：《浙江临床医学》2004年第5期366-367,共2页Zhejiang Clinical Medical Journal

摘　　要：目的 探讨切皮前静脉注入小剂量氯胺酮 -硝酸甘油复合异氟醚低流量循环紧闭吸入麻醉的可行性。方法 60例ASA(Ⅰ～Ⅱ )级择期手术患者 ,以相同麻醉方案诱导插管 ,采用5%高浓度异氟醚预充呼吸机气囊 ,并以相同的呼吸参数控制呼吸。然后实施异氟醚低流量 (Fl=0.5L/min)循环紧闭吸入麻醉 ,并随机分组 :A组于手术开始前30s静注氯胺酮硝酸甘油混合液0.1ML/kg(氯胺酮100mg+硝酸甘油0.2mg稀释成20ml) ;B组静注异丙酚0.5mg/kg并以4μg/kg/h微泵维持。两组术中均定时追加肌松剂并随时调节用药速度以维持麻醉。观察各组切皮前后循环及血糖变化。结果 两组手术开始时BP较术前均有所下降 ,手术开始后血压有所上升并稳定于较理想状态 (较术前低10mmHg左右 );B组手术开始时的收缩压较术前为低 ,且差异有显著性意义 (p<0.05)。两组手术开始后血糖均有所上升 ,且以B组上升更为明显。结论 切皮前一次性静脉注入小剂量氯胺酮 -硝酸甘油能够和异丙酚同样起到加深异氟醚低流量循环紧闭麻醉的效果 ,而前者更为经济、便捷。Objective To evaluate the feasibility of intravenous low-dose Ketamine-Nitroglycerin(KET-NTG)added to the low-flow closed circuit anesthesia with isoflurane before operation. Method 60patients(ASA I-II and aged22-75years)undergoing selective cholecystectomy under general anaesthesia of isoflurance inhalation with the same induced scheme,were randomly divided into two groups.The patients of group A were injected intravenously KET-NTG0.1ml/Kg(KET100mg and NTG0.2mg diluted to20ml normal saline)at30seconds before operation.While the paˉtients of group B were injected propofol0.5mg/kg and maintained with speed of4ug/kg/h through the micro-pump.To maintain the good anesthesia,the dose of propofol and concentration of isoflurane were regulated according to BP and HR during operation.The changes of BP/HR and blood glucose were observed before and after skin incision. Results The BP of both groups decreased before operation and rised after operation Initiation and kept stable during operation(10mmHg less than that of preoperation)The systolic pressure of group B was less than that of preoperation at operation Initiation and the difference was significant(P<0.05)The levels of serum glucose of both group were rised after operation initiation and which were more obvious in group B. Conˉclusion Intravenous low-dose KET-NTG cloud reach similar anesthesia effect to with disoprofol in low-flow closed circuit anesthesia with isoflurane before operation,but the former is more convenient and less cost.

关 键 词：静注 氯胺酮 硝酸甘油 异氟醚 低流量 循环紧闭 麻醉 小剂量 

分 类 号：R614[医药卫生—麻醉学]