氯胺酮对小儿术后静脉镇痛中芬太尼作用的影响

The Effect of Ketamine on the Ffunction of Fentanyl During Postoprative PCIA in Pediatric Patients

目的研究氯胺酮在小儿术后静脉自控镇痛中对芬太尼作用的影响。方法全麻下择期腹部手术病儿38例,病人随机分为两组,每组19例。F组芬太尼0.3μg/(kg.h),FK组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统计学差异(P>0.05)。两组中F组恶心、呕吐(16.0%)、静脉炎的发生率较KF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%,而且两组之间无统计学差异(P>0.05)。结论70μg/(kg.h)氯胺酮在静脉术后镇痛中能够增强芬太尼的镇痛作用,减少芬太尼的用量,从而减少副作用。

Objective To investigate the effect of Ketamine on the function of fentanyl during postoprative PCIA in pediatric patients. Methods 37 pediatric patients undergoing general anesthesia for elective abdominal surgery were randomly divided into 2 groups. Group F（ fentanyl 0.3g/kg·h） , Group FK （ fentanyl 0.2g/kg·h ＋ ketamine 70g/kg·h）, to accept intravenous postop-erative analgesia. The pain scores of VAS, sedation scores, the incidence of side-effect including itching, nausea, vomiting, and central excitatory phenometta, and SpO2 were recorded at 6 h, 24 h, 36 h and 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 among 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）. No case with central excitatory phenomena was found in each group. At each time point , no significant difference was found in SpO2 among these groups （P〉0.05） , and all the SpO2 values were not less than 96 %. Conclusion Low dose of ket-amine（70g/kg·h） can augment the analgesic effect of PCIA with fentanyl, lower the dosage consumption of fentanyl in pediatric patients, and reduce its side effteet.