亚麻醉剂量氯胺酮治疗急性严重哮喘的临床疗效分析

目的　评价应用亚麻醉剂量氯胺酮处理经内科治疗无效的急性严重哮喘及围术期顽固性支气管痉挛临床效果。方法　在内科常规治疗的基础上行SaO2 、EKG、NIBP及血气分析等监测 ,先予安定 0 2mg/kg或咪唑安定 0 15mg/kg缓慢静注 ,再予东莨菪碱 0 3mg/kg,5～ 1 0min后给予 1 %氯胺酮 0 5～ 0 75mg/kg缓慢静注 (>6 0秒 ) ,继以 0 1 %氯胺酮 0 1 5mg/kg/h静滴 ,维持 8～ 1 2h。治疗过程用面罩吸氧或面罩加压吸氧 ,7例手术后病人用药后联用呼吸机以SIMV方式辅助呼吸。结果　 36例病人经治疗后症状迅速改善 ,支气管痉挛明显缓解 ;SaO2 由 6 5 %～ 85 %上升至 90 %～ 98% ;血气分析明显好转 (治疗前后对比P <0 0 1 )。结论　对内科常规治疗无效的哮喘病人 ,应用亚麻醉剂量氯胺酮治疗不失为一种有效的方法。但强调应用者必须熟炼掌握人工通气技术并有专业麻醉人员协助下进行 ;同时 ,治疗过程必须配合其他治疗措施 ,病人的抢救成功是综合治疗的结果。

Analysis of Clinical Curative Effect of The Usage of Subanesthetic Dose of Ketamine to Treat Acute Severe Asthma

Objective To evaluate the clinical effects of subanesthetic dose of Ketamine in dealing with acute severe asthma which had no reaction to traditionally medical treatment and intractable perioperative bronchial spasm. Methods Scopolamine 0 3 mg/kg was administered after valium 0 2 mg/kg or midazolam 0 15 mg/kg slowly administered intravenously. Five to ten minutes later,1% ketamine 0 5～0 75 mg/kg was injected intravenously (>60 seconds), following by 0 1% ketamine dripped intravenously at the rate of 0.15 mg/kg/h for 8 to 12 hours. SaO 2, EKG, NIBP and blood gas analysis were monitored during the course. Oxygen was given through a mask. Respirator was used in 7 cases to assist ventilation. Results The symptoms of cases improved quickly after treatment, bronchial spasm relaxed immediately. SaO 2 raised from 65～85% to 90～98%. The results of blood gas analysis improved too ( P <0 01). Conclusion The usage of subanesthetic dose of ketamine to treat asthma which had no reaction to traditionally medical treatment was an effective method. But the user should master the manual ventitalion technology skillfully and be helped by professional anesthetists, meanwhile, other therapeutic methods should be used. The successful salvage of patients was the result of combining therapy.