丙泊酚复合芬太尼或氯胺酮用于吸毒患者手术的麻醉体会

摘要

目的 研究丙泊酚复合芬太尼或氯胺酮用于吸毒患者手术的麻醉处理.方法 516例吸毒患者按相同手术随机分为两组,均在术前持续微泵输注丙泊酚2.5～3 mg/kg,Ⅰ组258例,切皮开始前2分钟静注芬太尼2～3μg/kg;Ⅱ组258例,切皮开始前2分钟静注氯胺酮1 mg/kg,两组均术中酌情追加剂量.连续监测无创血压、心电图、脉搏血氧饱和度(SpO2).结果 与术前比较,术中Ⅰ组平均动脉压(MAP)、心率(HR)显著下降,SpO2差异无显著性(P＞0.05);Ⅱ组平均动脉压(MAP)、心率(HR)明显增高(P＜0.05),SpO2差异无显著性(P＞0.05),两组术程均未出现戒断症状,效果满意.结论 丙泊酚复合芬太尼或氯胺酮不仅可以防治戒断症状,而且可以增强麻醉效果.术中要注意加强监护,维护呼吸循环的稳定.%Objective To investigate the effect of propofol combined with fentanil or ketamine for anesthesia in drug abusers. Methods 516 drug abusers were randomly assgined to receive continuous preoperative injection of propofol of 2.5-3 mg/kg and then either intravenous fentanil of 2-3 μg/kg (258patients, group Ⅰ ) or ketamine of lng/kg (258 patients, group Ⅱ). Additional doses of fentanil or ketamine were added when necessary. Blood pressure, ECG and SpO2 were continuously monitored. Results As compared with the baseline values, MAP and HR significantly decreased in group Ⅰ (P＜ 0.05), while increased in group Ⅱ (P＜0.05); there was no significant difference in SpO2. No abstinent symptoms occurred in all the patients. Conclusions Propofol combined with fentanil or ketamine can not only prevent and treat abstinent symptoms but also enhance anesthestic effect. lntraoperative monitoring should be enhanced and the stability of respiration and circulation system should be maintained.