右美托咪定复合氯胺酮用于烧伤手术保留自主呼吸的临床效果

摘要

目的 探讨右美托咪定复合氯胺酮用于烧伤手术保留自主呼吸患者的临床效果.方法 四肢10％～30％Ⅱ～Ⅲ度烧伤患者60例,ASA Ⅰ或Ⅱ级,随机均分为研究组(M组)和对照组(K组),静注氯胺酮0.5mg/kg和丙泊酚1mg/kg诱导后,M组先泵入右美托咪定1μg/kg,10 min注完,然后以0.05 μg·kg-1·min-1维持,复合靶控输注丙泊酚2～4 μg/ml;K组靶控输注丙泊酚2～4 μg/ml.观察两组诱导前(T1)、诱导时(T2)、削痂结束时(T3)、取皮结束时(T4)、植皮结束时(T5)时的SpO2 、RR、VT、HR、MAP以及T1～T4时的血浆皮质醇、肾上腺素(E)、去甲肾上腺素(NE)以及苏醒时(T6)、苏醒10 min( T7)、苏醒20 min( T8)时的躁动评分(RS评分)和警觉/镇静评分(OAA/S).结果 K组在T2～T4时,M组在T2时RR明显慢于T1时,HR明显快于T1时,MAP明显高于T1时(P＜0.05),SpO2明显低于T1时(P＜0.05).在T3、T4时K组的血浆皮质醇、E和NE明显高于T1时和M组(P＜0.05).两组T6～T8时,K组RS明显高于M组(P＜0.05),T7、T8时OAAS明显低于M组(P＜0.05).术中丙泊酚、氯胺酮用量和术后PCIA用量K组均明显多于M组(P＜0.05).结论 右美托咪定复合氯胺酮用于烧伤手术能较好的镇静镇痛,抑制应激反应,不容易发生呼吸抑制,苏醒质量高.%Objective To investigate the clinical effect of dexmedetomidine combination with ketamine in surgery of empyrosis without mechanical ventilation. Methods Sixty ASA Ⅰ or Ⅱ patients with 10%-30% Ⅱ-Ⅲ limbs empyrosis were randomly assigned into control group (group K) and experimental group (group M). All patients were induced by 0. 5 mg/kg ketamine and 1 mg/kg propofol, then group K maintained by 2-4 μg/ml propofol (target controlled infusion). Group M was the same to group K, but maintained by additional infusion of 1 μg/kg dexmedetomidine in ten minutes and then maintained by additional infusion of 0. 05 μg·kg-1·min-1 dexmedetomidine. SpO2, RR, VT" HR, MAP of two groups were recorded before(T1) and after (T2) induction,at the end of tangential excision(T3), taking the skin (T4), skin grafting(T5). Cortisol, E and NE in plasma in surgery were measured at T1 -T4. The scores of RS and OAA/S were also observed at awake time (T6) and 10 min (T7) ,20 min (T8) later. Results RR in group K at T2-T4 and in group M at T2 were significantly slower than at Ti (P<0. 05). Compared with T1, HR were faster and MAP were higher,but SpO2 were decreased at T2 in group M and at T2~T4 in group K(P<0. 05). Cortisol, E and NE in plasma in group K at T3 ,T4 were higher than T, and group M at T7 ,T8 (P<0. 05). RS in group K was higher than that in group M at T6-T8 (P<0. 05), but OAA/S was lower than in group M at T7:T8(P<0. 05). The consumption of ketamine,dose of PCIA and propofol in group K were higher than those of group M(P<0. 05). Conclusion Dexmedetomidine combination with ketamine in surgery of empyrosis has many advantages. It can perfectly inhibit stress reaction, provide perfect conscious-sedation, analgesia and palinesthesia without inhibition of respiratory.