小剂量芬太尼与氯胺酮联合用于PCIA的临床体会

Clinical Experience of PCIA with Small dosage of Fentanyl and Ketamine

目的 观察微量小剂量芬太尼与氯胺酮联合于术后病人自控静脉镇痛（PCIA）的效果及不艮反应，并与较大剂量芬太尼PCIA进行比较。方法 选择ASAⅠ～Ⅱ级、年龄（45．8±11．2）岁、全麻下行腹部手术病人80例，随机分为4组：Ⅰ组为芬太尼2．0mg，Ⅱ组为芬太尼1．5mg＋氯胺酮250mg，Ⅲ组为芬太尼1．5mg＋氯胺酮500mg，Ⅳ组为芬太尼1．5mg＋氯胺酮750mg；各组均加5mg氟哌啶，然后加生理盐水至100mL。PCIA持续输注速度为24μL·kg^-1·h^-1。记录术后4、24、48及72h的VSA评分、镇静评分、呼吸次数及SpO2变化情况。结果 Ⅱ组VAS评分4个时点均明显高于Ⅰ组（P〈0．05或P〈0．01）。Ⅰ组出现睡眠的病人也较多。结论 适量小剂量芬太尼与氯胺酮联合用于术后PICA，能明显改善病人嗜睡的状况，镇痛效果也较理想，从而减少了术后嗜睡和呼吸抑制的状况。

Objective To observe the effect and side effect of small dosage of fentanyl and ketamine in PCIA and compare with large dosage of fentanyl. Methods 80 cases of ASA Ⅰ～Ⅱ （ age 45.8 ±1 1. 2） who received abdominal operation were divided into 4 group; group A （2. 0mg fentanyl）, group B （1.5mg fentanyl and 250mg ketaminc） ,group C （1.5mg fentanyl and 500mg ketamine） and group D （1.5mg fentanyle and 750mg ketamine）. All groups were added 5mg dropefidol and 100ml saline with 24u/kg/h. The VSA, sedative score, breathe and SpO2 at 4, 24, 48 and 72 hours after operation were reeoded. Resadts The VAS more in group B was lfigher than group A in 4 points （ P 〈 0.05）. The sleep in group A was obvious. Conclusion The small dosage of fentanyl and ketamine in PCIA might improve the lethary with good analgesia effect so that to decrease the inhibition of breathe.