小剂量氯胺酮抑制瑞芬太尼麻醉后痛敏反应的临床研究

The suppressive effects of low-dose Ketamine on the patients with postoperative hyperalgesia after remifentanil-based Anaesthesia

目的研究小剂量氯胺酮对瑞芬太尼麻醉术后痛敏反应的抑制作用,为临床合理应用瑞芬太尼提供理论依据。方法选择ASA I～Ⅱ级妇科行腹腔镜检和宫腹腔镜检手术患者90例,随机分为对照组(C)、瑞芬太尼组(R组)、小剂量氯胺酮组(K组),每组30例。3组均采用静吸复合麻醉,除I组外另二组用瑞芬太尼诱导与维持,手术近结束缝合皮肤时K组静脉给予氯胺酮0.5mg/kg,C组和R组暂不给药,术毕送恢复室,当患者出现中等程度疼痛时给予曲马多2mg/kg。记录3组患者拔除气管导管后的口述疼痛评分(VRS),再次要求镇痛的时间和拔管后24h内的不良反应。结果1)C组的VRS评分低于R组,差异显著(P<0.05);2)K组的VRS评分明显低于C组和R组,差异显著(P<0.05);3)所有组无一例要求再次镇痛;4)3组间麻醉后不良反应无统计学差异(P>0.05)。结论大剂量瑞芬太尼麻醉可引起术后早期痛觉超敏;小剂量氯胺酮对瑞芬太尼麻醉术后痛觉超敏有明显的抑制作用。

Objective To study the suppressive effects of low-dose ketamine on postoperative hyperalgesia after remifentanil-based anaesthesia. Methods A total number of ninety ASA Ⅰ-Ⅱ famale adult patients who undergone the operation of hysteroscope and peritoneoscope on were assigned to three groups randomly. Controll-ed group （Group C）, remifentanil group（（Group R） and low-dose ketamine group （Group K）. Before the end of surgery Group K was given ketamine 0.5 mg/kg and Group C and R wasn＇t given any medicine. When the patients feel the moderate ache tramadol 2mg/kg was given.VRS score,the time of requiring analgesia by patients and adverse drug reactions such as nausea, vomit,diplopia and hallucination were recorded for 24 hours after surgery. Results After operation the VRS score of Group C was lower than group R（P〈0.05） and Group K was lower than other groups （P〈0.05）. All groups hadn＇ t requiting analgesia any more.The adverse drug reaction showed no significant difference in three groups. Conclusion Low-dose ketamine has significant suppressive effect on patients with postoperative hyperalgesia after remifentanil-based anaesthesia.