小剂量氯胺酮辅助芬太尼镇痛对患者术后C-反应蛋白和白细胞介素-6的影响

THE EFFECTS OF FENTANYL PLUS LOW-DOSE KETAMINE ON POSTOPERATIVE SERUM LEVELS OF CRP AND IL-6

目的:观察小剂量氯胺酮辅助芬太尼术后镇痛效果以及对患者术后血清C-反应蛋白(CRP)和白细胞介素-6(IL-6)水平的影响。方法:择期全身麻醉下行上腹部手术患者60例,随机分为三组,I组患者不接受静脉自控镇痛(PCIA);II组患者以芬太尼行PCIA;III组患者以芬太尼+氯胺酮行PCIA。监测患者术后48h内生命体征、疼痛视觉模拟评分(VAS)、焦虑视觉模拟评分(AVAT)以及患者对镇痛治疗的总体印象评分(PJA)。分别于术前和术后抽取静脉血测定血清CRP和IL-6浓度。随访镇痛相关并发症。结果:II、III组患者术后生命体征、VAS、AVAT、PJA明显优于I组(P<0.05);III组患者VAS、AVAT、PJA优于II组(P<0.05)。患者术后血清CRP和IL-6浓度II、III组低于I组(P<0.05);III组患者低于II组(P<0.05)。结论:术后镇痛中小剂量辅助使用氯胺酮可以在一定程度上降低炎症反应,缓解手术后应激反应,提高术后镇痛效果。

Objective： To investigate the effect of postoperative analgesia with fentanyl and low-dose ketamine and the influence on the levels of serum CRP and IL-6. Methods. Sixty patients were divided into three groups randomly： group Ⅰ （without patient-controlled intravenous analgesia （PCIA））, group Ⅱ （PCIA with fentanyl）, and group Ⅲ（ PCIA with fentanyl plus low-dose ketamine）. The vital signs within 48 h, VAS, anxiety visual analog test （AVAT） and the patient＇s judgments on analgesia （PJA） were measured. Blood samples were taken before and after the surgery to assay the levels of serum CRP and IL-6. The complications of analgesia were followed up. Results： The vital signs, VAS, AVAT and PJA of the group Ⅱ and group Ⅲ were significantly better than those of the group Ⅰ （ P 〈 0.05 ）. The VAS, AVAT and PJA of the group Ⅲ were better than those of the group Ⅱ （ P 〈 0.05 ）. The postoperative levels of serum CRP and IL-6 of the group Ⅱ and Ⅲ were lower than that of group Ⅰ （P 〈 0.05 ）, and group Ⅲ lower than group Ⅱ （ P 〈 0.05 ）. Conclusion： Low-dose ketamine can help decrease the inflammatory response and postoperative stress, and enhance the analgesic effect.