丙泊酚和芬太尼复合亚麻醉剂量氯胺酮在乳腺手术中的应用

目的：探讨丙泊酚（P）、芬太尼（F）联合亚麻醉剂量氯胺酮（K）全凭静脉麻醉在乳腺区段切除术中的应用效果。方法：选择择期乳腺区段切除手术病人75例，ASAⅠ～Ⅱ级，随机分为3组，每组25例。组I：P＋F；组Ⅱ：P＋K和组Ⅲ：P＋F＋K。麻醉诱导：静脉注射（iv）注丙泊酚（1.5±0.3）mg/kg，2min后组Ⅰ iv芬太尼3μg/kg；组Ⅱiv氯胺酮1mg/kg；组Ⅲ iv氯胺酮0.4mg/kg，芬太尼1μg/kg。麻醉维持：恒速输注丙泊酚，酌情追加芬太尼和氯胺酮。结果：组Ⅲ术毕苏醒时间与组Ⅱ相比明显缩短（P＜0.05）。组Ⅲ芬太尼用量与组I比明显减少（P＜0.05）。组Ⅲ氯胺酮用量比组Ⅱ比明显减少（P＜0.05）。组I和组Ⅱ术中发生呼吸抑制等并发症明显高于组Ⅲ（P＜0.05）。组Ⅱ术中平均动脉压明显高于术前及组Ⅲ（P＜0.05）。组Ⅱ苏醒期精神症状等不良反应明显高于组Ⅲ。结论：丙泊酚、芬太尼联合亚麻醉剂量氯胺酮全凭静脉麻醉用于乳腺区段切除术是一种较为良好的麻醉方法。

Application of propofol and fentanyl combined with subanesthetic dosage of ketamine in breast surgery

Objective：To investigate the anesthetic effects of propofol （P） and fentanyl （F） combined with subanesthetic dosage of ketamine （K） in breast surgery. Methods ： Seventy- five patients,ASA classification Ⅰ-Ⅱ , scheduled for breast surgery were included in our study. The patients were randomly divided into 3 groups,Group Ⅰ ：P＋F;Group Ⅱ .P＋K and Group Ⅲ ：P＋F＋K. The induction of anesthesia was achieved by intravenous injection of following anesthetics respectively：propofol （1.5±0. 3）mg/kg for each group, 2 minutes later,fentanyl 3μg/kg for Group Ⅰ , ketamine 1mg/kg for Group Ⅱ and ketamine 0. 4mg/kg,and fentanyl 1μg/kg for Group Ⅱ The maintenance of anesthesia was conducted by continuous infusion of propofol and intermittent injection of fentanyl and/or ketamine. Results： The recovery time of Group Ⅲ was significantly shorter than that of Group Ⅱ （P 〈 0.05）. The dosage of fentanyl used in the surgery was significantly reduced in Group Ⅲ compared to Group Ⅱ （P〈 0.05）. Compared to Group Ⅱ ,the dosage of ketamine was significantly decreased in Group Ⅲ（p 〈 0.05）. However,the incidence of respiratory depression in Group Ⅰ and Group Ⅱ was significantly higher than that of Group Ⅲ （P〈 0.05） and the mean arterial blood pressure of Group Ⅱ was significantly higher than that of Group Ⅲ （P 〈 0.05）. In Group Ⅱ ,the incidence of psychiatric symptoms in the recovery period was significantly higher than that of Group Ⅲ （p 〈 0.05）. Conclusion. The recipe of propofol （P） and fentanyl （F） combined with subanesthetic dosage of ketamine （K） in the general anesthesia of breast surgery was more effective and shows few psychiatric symptoms compared with the combination of propofol with fentanyl or ketamine.