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咪唑安定和 或氯胺酮全麻诱导的临床效应观察 |
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傅维安 王珊娟 杭燕南 孙大金
摘要 目的：观察咪唑安定和／或氯胺酮麻醉诱导的临床效应。方法：全麻气管插管病人36例，ASAⅠ～Ⅱ级，随机分为三组，每组12例。分别静注咪唑安定0.1mg／kg＋氯胺酮1mg／kg（Ⅰ组）、氯胺酮2mg／kg（Ⅱ组）或咪唑安定0.2mg／kg（Ⅲ组）诱导。分别记录诱导前后各组的BIS、SEF、HR及MAP等变化。结果：①Ⅱ组诱导后BIS、SEF值低于其他组，而Ⅰ组诱导2分钟后的数值≥麻醉前值；②Ⅰ、Ⅲ组诱导后MAP和HR值比Ⅱ组平稳；③Ⅱ组术后2例出现恶梦。结论：①咪唑安定与氯胺酮联合诱导可导致BIS、SEF值升高；②咪唑安定能有效预防氯胺酮引起的心血管兴奋作用及恶梦；③咪唑安定0.1mg／kg可使氯胺酮的诱导剂量减少。
关键词 咪唑安定 氯胺酮 全麻诱导
Clinical Study on Co-induction of Midazolam and Ketamine
Fu Weian，Wang Shanjuan，Hang Yannan，et al
Department of Anesthesiology，Lu Wan District Central Hospital，Shanghai 200020
Abstract Objective：Investigating the clinical effectiveness of co-induction of midazolam and ketamine．Methods：36 patients ASA grade Ⅰ～Ⅱ，scheduled for endotracheal anesthesia were randomly allocated into 3 groups，with 12 cases each．Midazolam 0.1mg／kg together with ketamine 1mg／kg（Group Ⅰ），ketamine 2mg／kg（GroupⅡ） or midazolam 0.2mg／kg（GroupⅢ） was given intravenously．Changes in BIS，SEF，HR and MAP were recorded before and after induction．Results：①BIS and SEF value were lower in group Ⅱ than those in other groups after induction．②After induction，HR and MAP value were higher in group Ⅱ than those in the other two，nightmare was noted in 2 cases after operation in this group．Conclusion：①Co-induction of midazolam and ketamine may result in the elevation of BIS and SEF value．②Midazolam can effectively prevent the cardiovascular excitability and nightmare caused by ketamine．③Midazolam 0.1mg／kg can reduce the induction dose of ketamine and shows more stable hemodynamic manifestation．
Key words Midazolam Ketamine Co-induction
本研究通过观察咪唑安定和／或氯胺酮在全麻诱导时脑电数量化参数双频指数（bispectral index，BIS）和边缘频率（spectral edge freqency，SEF）的改变，以及HR和MAP变化，并在麻醉后进行随访，兹报道如下。
资料与方法
一般资料 ASAⅠ～Ⅱ级择期腹部手术病人36例，无神经、精神疾病史，年龄46.8±14.0（16～73）岁，体重60.2±11.7kg，男22例，女14例。
麻醉方法 36例病人随机分为三组，每组12例。分别从肘前静脉先注入咪唑安定0.1mg／kg，入睡后继以氯胺酮1mg／kg（Ⅰ组），一次注入氯胺酮2mg／kg（Ⅱ组[1] [2] [3] 下一页
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