氯胺酮与芬太尼超前镇痛对内脏牵拉痛及术后镇痛的影响

Effects of ketamine combined with fentanyl in preemptive analgesia on visceral referred pain and postoperative analgesia

目的观察氯胺酮与芬太尼复合液超前镇痛对抑制腹部手术内脏牵拉痛的影响及术后镇痛情况的观察。方法选择60例ASAⅠ～Ⅱ级择期胆囊手术患者均于硬膜外麻醉下行胆囊切除术,随机分为两组,每组30人,即Ⅰ组(对照组):术前不施行超前镇痛;Ⅱ组(实验组):切皮前10min将氯胺酮30mg与芬太尼0.05mg用生理盐水稀释成5ml注入硬膜外腔,所有患者术后均行自控硬膜外镇痛(PCEA)。镇痛药物为0.225%罗哌卡因+3mg/L芬太尼,共100ml。观察两组患者术中牵拉反应、术后镇痛情况及并发症。结果Ⅱ组用药对抑制术中牵拉痛的效果明显优于Ⅰ组(P<0.01);Ⅱ组PCEA泵首次触发时间较Ⅰ组显著延长(P<0.01),48小时内有效触发次数显著减少(P<0.01),24小时PCEA泵总用量明显减少(P<0.05),术后并发症无明显差异。结论氯胺酮与芬太尼硬膜外超前镇痛能明显抑制术中牵拉痛,提供良好的术后镇痛效果,减少阿片类药物的用量。

Objective To study the effects of ketamine combined with fentanyl in preemptive analgesia inhibiting visceral referred pain in abdominal surgery and on pain relief after operation. Methods Sixty ASA Ⅰ-Ⅱ patients（33 male, 27 female） undergoing elective chdecystectomy under epidural anesthesia were randomly divided into 2 groups. Group Ⅰ （control group）did not receive preemptive analgesia（n=30）, and group Ⅱ （experiental group） rec：eived epidurally ketamine 30mg with fentanyl 0.05rag added ten minutes before skin incision （n=30）. All patient received PCEA after operation. The PCEA solutions contained 0.225% ropivacaine and fentanyl 3mg/L. The operative referred pain, postoperative analgesic effects and complications were observed. Results The referred pain in operation was inhibited markedly in group Ⅱ more than group I （P〈0.01）; The time of first pressing of PCEA pump by the patient in group Ⅱ was longer than group Ⅰ （P〈0.01）,The number of successfully delivered doses in 48h was lower obviously in group Ⅱ than that in group I （P〈0.01）, The volume of PCEA solution administered in 24h was significantly lower in group Ⅱ than that in group I （P〈0.05）. There was no significant difference of postoperative complications between the two group. Conclusions ketamine combined with fetanyl in preemptive analgesia can obviously inhibit operative referred pain, provide adequate pain relief after operation, and reduce opiate drug consumption.