小剂量氯胺酮辅助芬太尼用于小儿术后静脉镇痛

Continuous intravenous infusion of low dose of ketamine combined with fentanyl used in pediatric patients

目的研究小剂量氯胺酮辅助芬太尼在小儿术后静脉自控镇痛中应用的可行性和安全性。方法全麻下择期腹部手术患儿36例,患者随机等分为两组。F组芬太尼0.3μg/(kg.h),FK组芬太尼0.2μg/(kg.h)+氯胺酮70μg/(kg.h)静脉术后镇痛治疗。分别于手术结束后6、24、36、48h记录疼痛、镇静评分、发生的不良反应(瘙痒、恶心呕吐、精神症状)、血氧饱和度。结果FK组的疼痛评分在各时间点均明显低于F组在相同时间点的疼痛评分(P<0.05)。两组之间的镇静评分无显著性差异(P>0.05)。两组中F组恶心、呕吐、静脉炎的发生率较FK组高(P<0.05)。两组中均未出现具有精神症状的病例。两组的血氧饱和度值在各时间点均不低于96%,而且两组之间差异无统计学意义(P>0.05)。镇静。结论70μg/(kg.h)氯胺酮在术后静脉镇痛中能够增强芬太尼的镇痛作用,减少芬太尼的用量,并减少不良反应。

Objective To evaluate the effect and the side-effect of continuous intravenous infusion of low dose of ketamine com-bined with fentanyl for postoperative analgesia in pediatric patients undergoing abdominal surgery. Methods 36 pediatric patients undergoing general anesthesia for elective abdominal surgery were divided randomly into 2 groups. Group F（ fentanyl 0. 3 μg/（ kg · h）, Group FK（ fentanyl 0.2 μg/（ kg · h） ＋ ketamine 70μg/（kg · h）, to accept intravenous postoperative analgesia. The pain scores of VAS, sedation scores, the incidence of side-effect including itching, nausea, vomiting, and central excitatory phenomena, and SpO2 were recorded at 6 h,24 h,36 h,48 h after operation. Results The pain score of group FK at each time point was significantly lower than that of group F（ P 〈 0. 01 ）. There was no significant difference between the two groups（ P 〉 0.05 ）on sedation scores. The incidence of nausea, vomiting, or itching of Group F was higher than group KF（P 〈 0.05 ）. None with central excitatory phenomena was found in each group. At each time point, no significant difference was found in SpO2 values between these groups（P 〉 0.05 ）, and all the SpO2 values were not less than 96%. Conclusion Low dose of ketamine augments the analgesic effect of PCIA with fentanyl in pediatric patients with a reduction of fentanyl consumption.