摘要：
目的 探讨右美托咪定-氯胺酮静脉复合用于膝关节镜手术麻醉的可行性.方法 择期行膝关节镜手术的患者50例,年龄18～60岁,ASA Ⅰ级或Ⅱ级,随机分为右美托咪定-氯胺酮组(D-K组)和丙泊酚-芬太尼组(P-F组),每组25例.D-K组给予右美托咪定(负荷量1μg· kg-1,继以1.5 μg·kg-1·h-1持续泵注)和氯胺酮(负荷量0.5 mg·kg-1,继以1 mg·kg-1·h-1持续泵注)静脉复合麻醉；P-F组给予靶控输注丙泊酚(起始靶浓度3 mg·L-1)和静脉注射芬太尼2 μg· kg-1复合麻醉.观察警觉与镇静(OAA/S)评分、脑电双频指数(BIS)、脉搏血氧饱和度(SpO2)等指标,记录麻醉诱导时间、定向力恢复时间以及不良反应情况,术后调查手术者及患者满意度.结果 D-K组患者术中呼吸维持平稳,SpO2均在96％以上,呼气末CO2分压维持正常；P-F组共有19例SpO2低于90％,需要放置通气道和(或)辅助通气,2组差异显著(P＜0.05).D-K组术中血流动力学较P-F组更加稳定,但当BIS≤60时心率下降明显.D-K组麻醉诱导时间和定向力恢复时间长于P-F组(P＜0.05).2组患者及手术医师对麻醉效果的满意率相仿.结论 右美托咪定-氯胺酮复合可安全用于膝关节镜手术的麻醉,对呼吸无明显抑制作用,可使血流动力学更加稳定,为此类保留自主呼吸的麻醉提供了安全保障.%IM To investigate the feasibility of dexmedetomidine-ketamine combination in knee arthroscopy. METHODS Fifty patients with ASA I or II , aged 18-60 years, scheduled for knee arthroscopy were randomly divided into two groups (25 patients in each) . In the D-K group, dexmedetomidine (a bolus of 1 μg·kg-1 was administered for 10 mins, followed by 1.5 μg · kg-1 · h-1 infusion during the operation) and ketamine (a bolus of 0.5 mg-kg-1 was administered, followed by 1 mg-kg-1· h-1 infusion during the operation) were applied. In the P-F group, target-controlled infusion of propofol (the target plasma concentration was set at 3 μg·L-1) and 2 μg·kg-1 fentanyl were given. The observer' s assessment of alertness/sedation (OAA/S)scale, bispeotral index (BIS), respiratory rate (RR), end-tidal carbon dioxide tension (PeiCO2), mean arterial blood pressure (MAP) , pulse oxygen saturation (SpO2) and heart rate ( HR) were continuously monitored. Induction time, orientation recovery time and adverse reactions were also recorded. Level of satisfaction with quality of anesthesia was evaluated by patients and surgeons. RESULTS The patients in the group D-K did not have significant respiratory depression (SpO2 ≥ 96% and PprCO2 remained normal) . In the P-F group, 19 patients (SpO2 ≤S 90%) altogether had to insert orophatyngeal airway or give assisted ventilation. Compared with the P-F group, the hemodynamic in the D-K group was more stable, but HR decreased significantly when BIS ≤ 60. The induction time and orientation recovery time of D-K group were longer than those of P-F group (P < 0.05) . There was no significant difference in the level of satisfaction with quality of anesthesia evaluated by patients and surgeons between two groups. CONCLUSION Dexmedetomidine-ketamine combination has light influence on breathing and more stable hemodynamic and is safe and feasible in knee arthroseopy.
