| 摘要: |
| ［摘要］ 目的 探讨氯胺酮配伍硫酸镁（KMS）静脉复合麻醉应用于临床的安全性、临床麻醉效果及适用范围。方法 （1）在动物和临床初步研究的基础上，确定三种不同浓度KMS的最佳配伍剂量(KMS复合液Ⅰ、Ⅱ、Ⅲ号)，先静注安定0.1～0.2 mg·kg-1诱导麻醉，后静滴KMS复合液Ⅰ号，根据麻醉需要用琥珀胆碱100 mg行气管内插管。麻醉维持先静滴KMS复合液Ⅱ号1个剂量，后改用KMS复合液Ⅲ号维持至麻醉结束，麻醉过程根据病人心率、血压变化和流泪等改变控制KMS复合液滴注速度。（2）对四种不同情况KMS麻醉法进行临床比较研究。结果 （1）本组所有病例全部获得快速诱导、麻醉平稳等理想效果，各时段点收缩压（SBP）、平均动脉压（MAP）和心率（HR）均无统计学差异(P>0.05)；术后24～78 h随访，术中止痛完善、无知晓，苏醒过程平顺。（2）四种不同情况的KMS麻醉法临床比较表明：①硫酸镁复合芬太尼组与普鲁卡因复合芬太尼组在麻醉过程中的收缩压（SBP）、舒张压(DBP)、心率（HR）、血糖(BG)、促肾上腺皮质激素(ACTH)、皮质醇（Cortsol）、生长激素(HGH)无统计学差异（P>0.05）；②KMS静脉麻醉组与芬太尼复合安氟醚静吸麻醉组（FE）比较，各时段点的SBP、DBP和HR均无统计学差异（P>0.05）；③老年病人KMS静脉复合麻醉组与芬太尼复合安氟醚麻醉组比较，FE组气管插管前及插管时的平均动脉压(MAP)、每搏输出量（SV）、SBP、HR等指标比麻醉前明显下降（P<0.05），比KMS组相应时段低（P<0.5），KMS组麻醉后各相应时段的心率收缩压乘积（RPP）比FE组低（P<0.01）；④心脏不停跳心内直视术中，KMS组HR、SBP和DBP均低于FE组，术中降压药硝普钠用量KMS组少于FE组（P<0.01）；术后多巴胺用量KMS组少于FE组（P<0.05）；术后7 d FE组有部分病例出现精神神经、眼科及心律失常等并发症状，KMS组无。结论 KMS静脉复合麻醉方法具有麻醉安全、起效快、并发症少、效果确切、麻醉过程平稳、循环功能稳定、苏醒过程平顺、价格低廉等优点，可广泛用于多种疾病及年龄段的手术麻醉。 |
| 关键词: 氯胺酮 硫酸镁 麻醉 静脉复合全麻 |
| DOI：10.3969/j.issn.1674-3806.2010.01.02 |
| 分类号:R 614.2 |
| 基金项目:广西卫生厅自筹经费科研计划课题（编号:桂卫Z 9723号） |
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| Study on clinical application of ketamine and magnesium sulfate intravenous combined anesthesia method |
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LI Dan-ya, LIN Cheng-xin, ZHANG Bing-dong, et al.
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The First Affiliated Hospital of Guangxi Medical University, Nanning 530021, China
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| Abstract: |
| ［Abstract］ Objective To study safety, effect and scope of the ketamine and magnesium(KMS) intravenous combined anesthesia in clinic.Methods （1）On the basis of the animals and clinical preliminary study, the best compatibility proportion of three different concentrations of KMS(KMS composite liquid Ⅰ, Ⅱ, Ⅲ) were identified. Intravenous drip of diazepam 0.1～0.2 mg·kg-1 was first used for anesthesia induction, subsequently intravenous drip of KMS composite liquidⅠ was performed.According to anesthesia need anectine 100 mg was used for intubation. A dose of KMS composite liquid Ⅱ was first used, then KMS composite liquid Ⅲ was used and maintained until the end of anesthesia. During anesthesia KMS composite fluid infusion rate was changed on the basis of the changes of patient heart rate, blood pressure,tears and other. （2）Comparison of four different KMS anesthesia was performed.Results （1）All cases of this study had rapid induction and stable anesthesia. the SBP, MAP and HR did not have significant difference at each time point(P>0.05). The follow-up in this group during the first 24～78 postoperative hours showed the satisfactory effects,such as improved pain relief, no consciousness and smooth awaking.（2） The clinical comparative study of four different KMS anesthesia method showed that: ①There was no significant difference between magnesium-fentanyl and procaine-fentanyl in SBP, DBP, HR, BG, ACTH, Cortsol, HGH during anesthesia(P>0.05). ②A comparative study between KMS intravenous anesthesia and fentanyl-enflurane inhalation-intravenous anesthesia showed that SBP,DBP and HR had no significant difference between two groups at each time point(P>0.05).③A comparative study between KMS intravenous anesthesia and fentanyl-enflurane anesthesia in the older patients showed that MAP,SV,SBP,HR and other indexes before and during endotracheal intubation in FE group significantly decreased than before anesthesia（P<0.05）,and these indexes were lower than KMS group at the corresponding time（P<0.5）.After anesthesia, the RPP of corresponding period in KMS group was lower than PE group（P<0.01）.④In the open heart surgery with beating heart, HR, SBP and DBP in KMS group were lower than those in the FE group. Intraoperative dosage of sodium nitroprusside in KMS group was less than that in FE group（P<0.01）;Postoperative dosage of dopamine in KMS group was less than that in FE group（P<0.05）. During the first 7 postoperative days, FE group appeared complications such as mental neurological symptoms, eye symptoms, severe arrhythmias, etc, but KMS group did not.Conclusion KMS intravenous anesthesia method has lots of advantages, such as safe, rapid onset of anesthesia, less complications, exact curative of effect, stable anesthesia，stable circulation，smooth awaking，rare nausea, low prices, etc. This method can be widely used for variety of anesthesia cases and the age of surgical anesthesia. |
| Key words: Ketamine Magnesium sulfate Anesthesia Intravenous combined anesthesia |
