伍用小剂量氯胺酮对前列腺切除术后自控硬膜外镇痛效果的影响

Effect of low-dose ketamine on efficacy of patient-controlled epidural analgesia after prostatectomy

目的:比较伍用小剂量氯胺酮对前列腺切除术后硬膜外自控镇痛效果的影响.方法:选择硬膜外腰麻联合麻醉下择期前列腺摘除术患者68例,术后随机分为A,B组,每组34例,均采用自控硬膜外镇痛(PCEA).A组:1.25g/L罗哌卡因和2mg/L芬太尼混合液,B组:A组+0.4g/L盐酸氯胺酮.单次自控镇痛(PCA)背景剂量3mL/h,PCA剂量2mL/次,锁定时间为10min,限量16mL/h.于术后4h和术后第1,2日的08:00,13:00,18:00时定期随访并记录患者在安静时(RVAS),运动时(MRAS)和咳嗽时(CVAS)的疼痛评分,Bromage运动阻滞评分,膀胱痉挛发生率,芬太尼耗量,膀胱冲洗液转清时间以及其副反应.结果:4h/24h,A组术后4,24h的RVAS评分及4,24,48h的芬太尼耗量均明显大于B组(P<0.05);两组膀胱痉挛的发生率和持续时间分别为27%,12%和(1.6±0.5)min,(0.7±0.3)min(P<0.05);膀胱冲洗液转清时间分别为(46±13)h,(34±11)h(P<0.05);A组的Bromage评分稍高于B组,但无明显差异;两组镇静评分以及副反应发生率相似.结论:罗哌卡因、芬太尼伍用小剂量氯胺酮是较为理想的硬膜外镇痛药配方,其镇痛效果良好且副反应小.

AIM： To evaluate the effect of low-dose ketamine on patient-controlled epidural analgesia （PCEA） in patients undergoing prostatectomy. /M[ETHODS： Sixty-eight patients receiving selective prostatectomy were randomly divided into 2 groups （ n = 34 in each group）. All patients received PCEA after the surgery. Drugs used for PCEA in group A were mixture of ropivacaine （1.25 g/L） and fentanyl（2 mg/L）. Drugs used in group B were those in group A plus ketamine（0.4 g/L）. The background dose of PCEA was 3 mL/h and the bolus dose was 2 mL. The lock time was 10 min and the maximal dose was limited to 16 mL/h. The RVAS, MVAS and CVAS, Bromage score, rate of cystospasm, consumption of fentanyl, time for bladder flush fluid to be clear and side effects were recorded at 4, 24 and 48 h after the surgery respectively. RESULTS： There was no difference in the VAS, Bromage score, rate of cystoapasm and fentanyl consumption between the 2 groups at 4 h postoperatively. The RVAS at 4 h or 24 h and the dose of fentanyl consumption at 4, 24 and 48 h after surgery in group A were significantly higher than those in group B （ P 〈 0.05 ）. The rate and duration of cystospasm in the 2 groups were 27%, （1.6 ±0.5） rain and 12%, （0.7 ±0.3） min, respectively（ P 〈 0.05 ）. The time for bladder flush fluid to be clear was （46 ± 13） h and （34 ± 11） h, respectively（P 〈 0.05 ）. Bromage score in group A was slightly higher than that in group B. However the difference was not significant. No significant difference was found in the sedative score and side effects rate between the two groups. CONCLUSION： Combination of low-dose ketamine with ropivacaine and fentanyl makes an ideal PCEA receipt with better analgesic effect and fewer side effects.