氯胺酮-丙泊酚复合全麻在大面积烧伤手术中的应用

目的探讨氯胺酮-丙泊酚复合全麻在大面积烧伤早期切痂植皮手术的麻醉效果、副作用的发生率、术后的恢复情况，并同期与传统的氯胺酮复合羟丁酸钠麻醉相比较，是否更具优越性。方法40例切痂植皮手术患者，随机分为氯胺酮-丙泊酚复合全麻组（Ⅰ组n=20）和氯胺酮-羟丁酸钠全麻组（Ⅱ组n=20）。全部病例静注芬太尼2μg／kg、丙泊酚2～3mg／kg、阿曲库铵0．3-0．5mg／kg做诱导插管，然后Ⅰ组微泵持续注射丙泊酚4～6mg／kg·h，45min间断静注阿曲库铵0．25-0．5mg／kg及氯胺酮1-2mg／kg维持。Ⅱ组微泵持续注射氯胺酮1-2mg／kg·h，45min间断静注阿曲库铵0．25～0．5mg／kg及羟丁酸钠80-100mg／kg。分别记录2组病例在用药期间的收缩压（SBP）、舒张压（DBP）、心率（HR），血氧饱和度（SpO2）、麻醉效果、停药后苏醒时间、苏醒后再入睡、副作用发生率等。结果Ⅰ组病例麻醉效果良好，循环稳定；而Ⅱ组术中血压有不同程度的升高，术中肢体有不自主的躁动现象，苏醒时间及拔管时间Ⅱ组比Ⅰ组明显延长（P〈0．05）。结论氯胺酮-丙泊酚复合全麻用于大面积烧伤早期切痂植皮手术，麻醉效果确切，可控性强，苏醒迅速而平稳，不良反应少，优于氯胺酮羟丁酸钠麻醉。

The application of Ketamine Combined with Propofol in general anesthesia for extensive burn operation

Objective To explore the anesthesia effect of Ketamine Combined with Propofol general anesthesia in excision of eschar and dermatoplasty of the forepart extensive burn, the rate of side-effect and the postoperative recovery. At the same time,to judge the superiority by comparing to the conventional Ketamine combined with Sodium Hydroxybutyrate anesthesia. Methods 40 cases of patients who received excision of eschar and dermatoplasty were divided into two groups randomly： the Ketamine Combined with Propofol general anesthesia group （ Ⅰ group n=20） and the Ketamine combined with Sodium Hydroxybutyrate anesthesia group （ Ⅱ group n=20）. All cases were inducted and received trachea cannula by intravenous injecting Fentanyl 2 μg/kg, Propofol 2-3 mg/kg and Atracuriumbesylate 0.3-0.5 mg/kg. Then, the group Ⅰ was injected Propofol 4-6 mg/kg·h by continuous pump-infusion, Atracuriumbesylate 0.25-0.5 mg/kg disconnectedly every 45 min, and maintained injecting Ketamine 1-2 mg/kg. The group Ⅱ was injected Ketamine 1 -2 mg/kg· h by continuous pump-infusion, Atracuriumbesylate 0.25-0.5 mg/kg and Sodium Hydroxybutyrate 80-100 mg/kg disconnectedly every 45 min. During medication, record two groups＇ SBP, DBP, HR, SpO2, anesthesia effect, palinesthesia time after stopping medication, sleeping again after palinesthesia and the rate of side-effect. Results The effect of the group Ⅰ was good and the blood circulation was stabilization. The blood pressure in the group Ⅱ had risen in different degrees and the patients＇ limbs had restlessness involuntarily during operation. The palinesthesia time and the cannula removing time were longer obviously than that of the group I （P〈0.05）. Conclusion Ketamine Combined with Propofol general anesthesia in excision of eschar and dermatoplasty of the forepart extensive burn is better than Ketamine combined with Sodium Hydroxybutyrate anesthesia, because of the doubtless effect, the well controllable, the rapid and smooth palinesthesia and less side-effect.