Waxman K, Shoemaker W C, Lippmann M
Anesth Analg. 1980 May;59(5):355-8.
Anesthetic induction with ketamine has been reported to maintain or improve cardiovascular performance in severely ill patients. Using invasive cardiovascular monitoring, we studied physiologic responses to a single dose of ketamine in 12 critically ill patients. Six patient demonstrated decreases in ventricular contractility, and four had decreases in cardiac output. Mean arterial blood pressure decreased in four patients. Pulmonary venous admixture increased in four of six patients, while oxygen consumption decreased in eight of 11 patients. Thus, a single dose of ketamine produced decreases in cardiac and pulmonary performance and in peripheral oxygen transport in this group of patients. It is proposed that in severely ill patients, preoperative stress may alter the usual physiologic responses to ketamine administration, and adverse effects may predominate. Ketamine, therefore, should be used with caution for induction of anesthesia in critically ill and in acutely traumatized patients until additional studies and further information on cardiovascular responses to ketamine are available.
据报道，氯胺酮诱导麻醉可维持或改善重症患者的心血管功能。我们采用有创心血管监测，研究了12例危重症患者单次使用氯胺酮后的生理反应。6例患者心室收缩力下降，4例心输出量下降。4例患者平均动脉血压下降。6例患者中有4例肺静脉混合血增加，11例患者中有8例氧耗量下降。因此，单次使用氯胺酮可导致该组患者心脏和肺部功能以及外周氧输送下降。有人提出，在重症患者中，术前应激可能会改变对氯胺酮给药的通常生理反应，且不良反应可能占主导。因此，在获得更多关于氯胺酮心血管反应的研究和进一步信息之前，氯胺酮应谨慎用于危重症患者和急性创伤患者的麻醉诱导。
