摘要
目的 探讨小剂量氯胺酮复合七氟烷吸入诱导对手术患者气管插管条件及血流动力学的影响.方法 选择择期行腹部手术的患者56例,随机分为观察组（24例）和对照组（32例）.麻醉诱导前,观察组静脉注射氯胺酮负荷量0.3 mg/kg并以14 μg·kg-1·min-1维持,对照组静脉输注等量0.9%氯化钠注射液.两组麻醉诱导均采用8%七氟烷潮气量诱导法,气管插管成功后使呼气末七氟烷浓度达到并维持在1.8%.气管插管条件评估采用哥本哈根评分（Copenhagen Score）,所有评分条件达到优秀或良好被界定为插管满意.监测、记录并比较入手术室后（T1）、气管插管前（T2）、气管插管后1min（T3）、5min（T4）、10min（T5）等时点收缩压、舒张压、心率.结果 观察组的插管满意率较对照组高,差异有统计学意义（P＜0.05）.两组收缩压、舒张压在T2时点较T1下降,差异有统计学意义（P＜0.01）.两组间收缩压、舒张压在T2、T3时点比较差异有统计学意义（P＜0.05）.观察组T3、T4、T5时点的心率均较对照组慢,差异有统计学意义（P＜0.01）.结论 小剂量氯胺酮可改善手术患者七氟烷诱导气管插管的条件,并且使血流动力更稳定.
Objective To investigate intubating conditions and hemodynamic effects of low-dose ketamine combined with sevoflurane induction in patients undergoing surgery. Methods Fifty six patients undergoing abdominal surgery from September 2010 to March 2011 were randomly divided into ketamine group（group K,n= 24） and control group （group C,n= 32）. Prior to the induction of anesthesia, patients in group K were intravenously administered with initial loading dose of ketamine 0.3 mg / kg,following by a maintaining dose at 14 μg·kg^-1·min^-1; while patients in group C were intravenously injected with normal saline. Anesthesia was induced with 8% sevoflurane tidal volume inhalation technique. After successful endotracheal intubation, the end-tidal concentration of sevoflurane were maintained at 1.8%. Intubating conditions were evaluated using the Copenhagen score system. Only patient with excellent or good score in all conditions was defined as satisfactory intubation; otherwise was recorded as poor intubation. Systolic blood pressure （SBP）,diastolic blood pressure （DBP）, heart rate （HR） were monitored and recorded at time points after burglary（T1）,before intubation （T2）,lmin（T3）,5min（T4） and 10min（T5） after intubation. Results SBP and DBP in both groups were decreased at T2 following T1. In group C,SBP and DBP increased at T3 compared to T1 （P〈0.01）;HR at T3, T4 and T5 was significantly faster（P〈0.05） than that of T1. Compared to the correspondent time points in group C,SBP and DBP of group K increased at T2; decreased at T3（P〈0.01）;HR of group K decreased at T3,T4 and T5（P〈0.01）. The proportion of patients with satisfactory endotracheal intubation from group K were significantly higher than that from group C （P〈0.05）. Conclusion Low-dose ketamine can improve intubating conditions of sevoflurane induction and provide a more stable hemodynamics in patients undergoing abdominal surgery.
出处
《浙江医学》
CAS
2012年第9期671-673,677,共4页
Zhejiang Medical Journal
基金
浙江省医药卫生科技计划项目（2011ZYC-A02）
