小剂量氯胺酮和芬太尼用于妇科术后病人自控镇痛的临床研究

LOW-DOSE KETAMINE COMBINED WITH FENTANYL FOR PATIENT CONTROLLED ANALGESIA AFTER GYNECOLOGICAL SURGERY

目的 :观察小剂量氯胺酮辅助芬太尼用于妇科手术后静脉病人自控镇痛 (PCIA)的临床效果和安全性。方法 :72例ASAI～II级、在椎管内麻醉下行择期妇科手术病人 ,随机分为三组 ,每组2 4例 ,术后行PCIA。配方I组为芬太尼 0 .75mg +氟哌啶 7.5mg +生理盐水至 15 0ml;II组和III组再分别加入氯胺酮 75mg、15 0mg并用生理盐水稀释至 15 0ml。PCIA设置 :负荷剂量 0 .1ml/kg ,单次给药剂量 0 .0 5ml/kg ,连续给药速度 0 .0 4ml/kg/h ,锁定时间 15分钟。术后 4h、8h、2 4h记录BP、P、RR、芬太尼用量、PCA按压次数 (demand)、疼痛评分 (VAPS)、镇静评分 (VASS)、疲倦评分(VATS)、恶心评分 (VANS)及副作用发生情况。结果 :术后 4h随访时芬太尼用量、PCA按压次数三组间无显著性差异 (P >0 .0 5 )。术后 8h、2 4h随访时III组芬太尼用量、PCA泵按压次数明显少于前二组 (P <0 .0 5 )。结论 :小剂量氯胺酮 (1.1μg /kg/min)与芬太尼联合用于椎管内麻醉妇科手术后PCIA能够减少芬太尼用量 ,并未增加副作用的发生 ,是安全有效的镇痛措施。而 0 .6 5 μg /kg/min的氯胺酮并不产生明显的芬太尼节省效应。

Objective: The analgesic effect, safety and side effects of different doses of ketamine combined with fentanyl and droperidol were investigated after gynecological operations. Methods: Seventy-two patients scheduled for gynecological operations under combined epidural and spinal anesthesia, epidural anesthesia or spinal anesthesia were randomized into three study groups. In group I, PCA drugs included fentanyl 0.75mg and droperidol 7.5mg diluted to 150 ml with normal saline. In group II and group III, 75mg and 150mg of ketamine were added respectively. At skin closure, all patients received a loading dose of 0.1ml/kg, followed by a continuous infusion(0.04ml/kg/h). PCA dose was 0.05ml/kg. Patients were observed at 4h, 8h and 24h after operation. Scores of pain , sedation, tiredness, nausea were evaluated, the numbers of PCA demanding and dosage of fentanyl , BP, P and RR were recorded. Results: The analgesia was satisfactory in all three groups. The PCA demand times and fentanyl dosage within 24h in group III were significantly decreased compared with group I and group II(P<0.05). Adverse effects of ketamine were not found in all the patients. Conclusions: Low dose of ketamine (1.1μg /kg/min) combined with fentanyl for postoperative PICA produced a better pain relieving effect. Adverse effects of ketamine were not found. However, 0.65μg /kg/min of ketamine did not decrease the dosage of fentanyl nor potentiated the analgesic effect.