氯胺酮与吗啡超前镇痛对内脏牵拉痛及术后镇痛的影响

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

目的探讨氯胺酮与吗啡复合液硬膜外超前镇痛对抑制手术内脏牵拉痛的影响及术后镇痛情况的影响。方法60例ASAⅠ-Ⅱ级择期全子宫切除术患者,均于硬膜外麻醉下行全子宫切除术。随机分为两组,每组30例,即Ⅰ组（对照组）：术前不施行超前镇痛;Ⅱ组（实验组）：切皮前10 min将氯胺酮30 mg与吗啡2 mg用生理盐水稀释成5 ml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0.15%罗哌卡因＋5 mg吗啡,共100 ml。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 h内有效触发次数显著减少（P〈0.01）,24 h PCEA泵总用量明显减少（P〈0.05）,术后并发症无明显差异。结论氯胺酮与吗啡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 ketaminc with morphine in preemptive analgesia inhibiting visceral referred pain in abdominal surgery and on pain relief after operation. Methods Sixty ASA Ⅰ - Ⅱ patients undergoing elective hysterectomy under epidural anesthesia were randomly divided into 2 groups. Group Ⅰ （ control group ） did not receive preemptive analgesia （ n = 30）, and group Ⅱ （ experiential group） received epidurally ketamine 30 mg with morphine 2rag added ten minutes before skin incision（ n = 30）. All patients received PCEA after operation. The PCEA solutions contained 0. 15% ropivacaine and morphine 5 mg. The operative referred pain, postoperative analgesia effects and complications were observed. Results The referred pain in operation was inhibited markedly in group Ⅱmore than group Ⅰ （ P 〈 0.01 ） ; The time offirst pressing of PCEA pump by the patients in group Ⅱ was longer than in group Ⅰ （ P 〈 0.01） ; The rumber of successfully delivered doses in 48h was lower obviously in group Ⅱthan in group Ⅰ（ P 〈 0.01） ; The volume of PCEA solotion 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 groups. Conclusions Ketamine combined with morphine in preemptive analgesia can obviously inhibit operative referred pain, provide adequate pain relief after operation, and reduce opiate drug consumption.