小剂量氯胺酮在术后静脉镇痛中的应用

Evaluation of the effects of low-dose ketamine on postoperative analgesia

目的观察小剂量氯胺酮在术后静脉芬太尼或舒芬太尼镇痛中的应用效果。方法200例ASAⅠ-Ⅱ级择期行骨科手术的患者,随机分为4组,即芬太尼组（F组）、芬太尼-氯胺酮组（FK组）、舒芬太尼组（S组）和舒芬太尼-氯胺酮组（SK组）,每组50例。所有患者镇痛模式均采用“负荷量＋背景量＋病人自控镇痛（PCA）量”（LMP）方式,各组镇痛药物配伍如下：F组芬太尼0.4μg/（kg·h）;FK组芬太尼0.2μg/（kg·h）＋氯胺酮120μg/（kg·h）;S组舒芬太尼0.04μg/（kg·h）;SK组舒芬太尼0.02μg/（kg·h）＋氯胺酮120μg/（kg·h）。各组镇痛药物均加入恩丹西酮8mg,并用生理盐水稀释至100ml。镇痛泵参数设置为负荷量2ml,背景量2ml/h,PCA量单次2ml,时间30min。所有患者均在手术结束前30min给予负荷量并连接镇痛泵。观察患者术后48h的心率、血压、呼吸频率、血氧饱和度、视觉模拟评分（VAS）、镇静评分（SS）及不良反应发生率,并记录患者48h内总按压次数。结果血压、心率及呼吸频率在4组患者中无显著性差异。F组VAS评分和总按压次数明显高于其他3组（P〈0.05）。S组患者SS评分显著高于其他3组（P〈0.05）。各组恶心、呕吐、瘙痒、肛门开始排气时间延长等不良反应发生率无显著差异。结论小剂量氯胺酮联合芬太尼或舒芬太尼应用于术后静脉镇痛治疗,效果满意,且降低了不良反应的发生率。

Objective To investigate the effects of low-dose ketamine combined with fentanyl or sulfentanyl in postoperative patientcontrolled intravenous analgesia. Methods Two hundred cases with ASA Ⅰ-Ⅱ undergoing elective orthopedic operations were randomly allocated into four groups （50 cases for each group）： 0.4btg/（kg·h） fentanyl （group F）; 0. 2μg/（kg·h） fentanyl＋120μg/（kg·h） ketamine （group FK） ; 0. 04μg/（kg·h） sulfentanyl （group S） ;and 0. 02μg/（kg·h） sulfentanyl＋120 μg/（kg·h） ketamine （group SK）. 8mg of ondansetron was added to each recipe, and then diluted into 100ml with normal saline. The loading doses of all the patient-controlled-analgesics were 2ml administered 30min before the end of the operation. The background infusion doses were 2ml/h, while the pressing doses were 2ml, with intervals of 30min. Heart rate （HR）, blood pressure （BP）, respiration rate （RR）, pulse 02 saturation and visual analogue scales （VAS）, sedation score （SS） with adverse effects and the total times of pressing PCA pump button were observed and recorded in all patients respectively for 48h after operations, Rsults No statistically significant differences were found in HR, BP and RR among the four groups. VAS and the total pressing times in group F were higher than that in the other groups significantly （P〈0. 05）. SS in group S was higher than that in the other groups significantly （P〈0. 05）. There were no obvious differences among the four groups in nausea, vomiting, itching, and the adverse reaction such as delayed passage of flatus. Conclusions Low-dose ketamine combined with fentanyl or sulfentanyl can improve postoperative patient-controlled intravenous analgesia with less adverse effects.