曲马多复合小剂量氯胺酮用于腹部手术患者的手术后镇痛：一项双盲、安慰剂对照的随机研究

背景鉴于氯胺酮联合曲马多用于患者手术后镇痛的研究较少，本文旨在验证曲马多复合氯胺酮能否改善腹部大手术的术后镇痛效果。方法在此项双盲、随机、对照研究中，行择期开腹手术的成年患者（n=120）随机分入氯胺酮组（氯胺酮手术中用量为0．3mg／kg，手术后以0．1mg·kg^-1·h^-1速度输注）或对照组（相同剂量和速度的生理盐水）。所有患者在手术中均使用曲马多3mg／kg，手术后48小时持续输注曲马多0．2mg·kg^-1·h^-1另以患者自控吗啡镇痛用于补救性镇痛。结果在整个48小时研究期间，氯胺酮组在静息（P=0．01）和活动（P=0．02）时的疼痛评分较低，吗啡的需求量较少（P=0．003）。在0～24小时期间，氯胺酮改善了患者主观的镇痛效果（P=0．008），镇静作用较小（P=0．03），需要医师干预的严重疼痛较少（P=0．01）。氯胺酮组中产生幻觉的患者较多，但两组的其他副作用均相似。结论腹部大手术后，小剂量氯胺酮是辅助吗啡和曲马多镇痛的有效药物。

BACKGROUND： There are few data on combining ketamine with tramadol for postoperative analgesia in humans. We tested the hypothesis that adding ketamine to tramadol would improve analgesia after major abdominal surgery. METHODS： In this double-blind, randomized, controlled trial, aduk patients （n =120） having elective laparotomy were randomly assigned to a ketamine group （intraoperative ketamine 0. 3 mg/kg and postoperative infusion at 0. 1 mg · kg^-1 ·h^-1） or control group （equivalent volume/rate of normal saline）. All patients received intraoperative tramadol 3 mg/kg and a tramadol infusion （0. 2 mg · kg^-1 ·h^-1） for 48 h postoperatively and had morphine patient-controlled analgesia available for rescue analgesia. RESULTS： The ketamine group had less pain at rest （P = 0. 01 ） and with movement （P = 0. 02） and required Iess morphine （P = 0. 003） throughout the 48-h study period. In the 0 -24 h period, ketamine improved subjective analgesic efficacy （P = 0. 008）, was less sedating （P = 0. 03）, and required fewer physician interventions to manage severe pain （P = 0. 01 ）. Hallucinations were more common in ketamine patients, but other side effects were similar. CONCLUSIONS： Small- dose ketamine was a useful addition to tramadol and morphine after major abdominal surgery.