小剂量氯胺酮联合舒芬太尼术后皮下镇痛在老年患者术后的应用

Low-dose Ketamine Combined Sufentanil Pain in the Skin after the Application of Elderly Patients

目的观察小剂量氯胺酮联合舒芬太尼皮下镇痛用于老年患者术后镇痛的有效性和安全性。方法择期手术患者40例，随机分为两组，每组20例，舒芬太尼＋氯胺酮组（舒芬太尼80μg＋氯胺酮200mg，加0．9％氯化钠溶液至100mL）和舒芬太尼组（舒芬太尼100μg加0．9％氯化钠溶液至100mL）。患者自控镇痛（PCA）设置：负荷量2mL，背景输注速度2mL／h，患者自控量0．5mL／次，锁定时间15min。在手术结束前30min开始持续皮下给药，镇痛后4、12、24、48h记录各项指标：视觉模拟评分、镇静程度、PCA按压次数和有效按压次数，并记录有无恶心、呕吐、呼吸抑制、皮肤瘙痒等不良反应。结果舒芬太尼＋氯胺酮组12h内静息镇痛评分明显低于舒芬太尼组（t=3．50，P〈0．05），但12h后两组则无统计学意义（P〉0．05）；两组12h的镇静评分比较差异有统计学意义（t=2．31，P〈0．05），其余时间无统计学意义；PCA按压次数和有效按压次数比较均无统计学意义（P〉0．05）。术后舒芬太尼组出现不良反应共6例，舒芬太尼＋氯胺酮组出现不良反应共3例，两组不良反应率比较差异有统计学意义（χ^2=108．80，P〈0．01）。术后24h未发生明显的血压、心率、呼吸频率和脉博血氧饱和度变化，两组均无幻觉及呼吸抑制发生。结论小剂量氯胺酮复合舒芬太尼用于老年患者术后皮下镇痛可减少舒芬太尼的用量，降低阿片药物的不良反应，具有安全性和实用性。

Objective To observe the analgesic efficacy and safety of the low-dose ketamine combined sufentanil for postoperative pain in elderly patients with the skin in postop. Methods surgery patients in 40 cases, were divided into two groups with each group of 20 cases, sufentanil ＋ ketamine group （ sufentanil 80μg ＋ketamine 200 mg,plus 0.9% saline to 100 mL） and the sufentanil group （sufentanil 100 μg plus 0. 9% Saline to 100 mL）. PCA ：load capacity 2 mL, background infusion rate of 2 mL/h, patient-controlled volume of O. 5mL/times ,lock time 15min. Surgery in 30min before the end of the beginning of continuous subcutaneous administration. 4,12,24,48 h after analgesia record indicators ： VAS score ; level of sedation ; the number of PCA push and the number of effective compression, and record the adverse effect information such as nausea and vomiting, respiratory depression, and itching skin ect. Results The rest Pain score within 12 hours of Sufentanil ＋ ketamine group was significantly lower than that of sufentanil group （ t = 3.50, P 〈 0.05 ）, but after 12 hours the two groups had no significant difference （ P 〉 0.05 ） ; It is different that the level of sedation of 12 h （ t = 2.31, P 〈 0.05 ） and there are no difference in other time （P 〉 0.05 ） between the two groups; There are no difference that the number of PCA push and the number of effective compression between the two groups（ P 〉 0.05 ）. The are 6 cases have the adverse effect in sufentanil group and 3 cases in sufentanil ＋ ketamine group,it is significant difference of the adverse effect rate between the two groups（ χ^2 = 108.80 ,P 〈 0.01 ）. There was no significant difference in BP, HR, RR and SPO2 after 24-hour, The two groups had no hallucinations and respiratory depression occur. Conclusion Low-dose ketamine combined sufentanil for elderly patients to reduce subcutaneous analgesia postoperative sufentanil usage, reduce the adverse effects of opioid drugs, and it is safe and pragmatic.