异丙酚复合瑞芬太尼气管插管与复合氯胺酮非气管插管麻醉在烧伤手术中的比较

目的比较异丙酚复合瑞芬太尼气管插管与复合氯胺酮非气管插管麻醉在烧伤手术中的特点。方法 60例择期烧伤手术病人,ASAⅠ-Ⅱ级,按序贯实验分为氯胺酮组（A组）和瑞芬太尼组（B组）,每组30例。A组麻醉诱导用安定和氯胺酮,维持麻醉用微量泵持续输注异丙酚和氯胺酮,术中保留自主呼吸并用鼻导管给氧;B组麻醉诱导用安定、阿曲库铵、丙泊酚、瑞芬太尼,气管插管后行机械通气,维持麻醉用微量泵持续输注瑞芬太尼、丙泊酚、阿曲库铵。观察麻醉前、麻醉诱导后、手术开始时、术中45 min、术毕5 min各时点的平均动脉压（MAP）、HR和SpO2的变化以及术后苏醒时间和术中、术毕时出现的不良反应。结果麻醉诱导后A组MAP明显增高（P〈0.05）,而B组MAP显著下降（P〈0.05）;2组比较,差异也有统计学意义P〈0.05）;麻醉诱导后A组SpO2明显下降（P〈0.05）,而B组SpO2稍有增高（但P〉0.05）;B组苏醒时间明显比A组短（P〈0.01）;A组术中易发生躁动、谵妄和呼吸抑制等不良反应。结论异丙酚复合瑞芬太尼气管插管麻醉用于烧伤手术,呼吸循环稳定,苏醒及时,不良反应少,提高了麻醉的安全性,且便于麻醉管理。

Comparison of Propofol and Remifentanil with Tracheal Intubation and Propofol and Ketamine without Tracheal Intubation in Burn Surgery

Objective To compare the characteristics of propofol and remifentanil with tracheal intubation and propofol and ketamine without tracheal intubation in burn surgery.Methods Sixty ASAⅠorⅡpatients undergoing elective burn surgery were randomly divided into ketamine group（group A,n=30） and remifentanil group（group B,n=30）.In group A,anesthesia was induced with diazepam and ketamine and maintained by pumping propofol and ketamine without tracheal intubation.In group B,anesthesia was induced with diazepam,atracurium besilate,propofol and remifentanil,and then the patients were mechanically ventilated after tracheal intubation,and anesthesia was maintained by pumping propofol,atracurium besilate and remifentanil.The changes of MAP,HR,SpO2 and untoward effect during and after surgery were observed at five different time：points-pre-anesthesia（T1）,post anesthesia induction（T2）,0 minute（T3）,45 minutes post beginning of surgery（T4） and 5 minutes post surgery（T5）.Results MAP was rose significantly at T2 in group A（P〈0.05）,but declined significantly in group B（P〈0.05）.SpO2 declined at T2 in group A（P〈0.05）,but rose in group B（P〉0.05）.The recovery time in group B was shorter than that in group A（P〈0.01）.The untoward effects such as dysphoria,phrenitis and respiratory inhibition happened in the patients in group A.Conclusion Because of the stable respiratory and circulatory system,awaking up in time and less untoward effects,anesthesia with propofol and remifentanil with tracheal intubation is safe and manageable in burn surgery.