小剂量氯胺酮联合吗啡用于妇科开腹患者术后静脉镇痛的研究

Continuous Intravenous Infusion of Low Dose of Ketamine Combined with Morphine Used For Postoperative Analgesia in Patients Undergoing Abdominal Gynecological Surgery

目的比较小剂量氯胺酮联合吗啡在妇科开腹患者术后静脉镇痛中的临床效应及副作用的发生率,并探讨氯胺酮的合适剂量。方法将99例在硬膜外麻醉下接受全子宫切除术患者随机分成三组:M组接受吗啡0.02mg/(kg.h),MK1组接受吗啡0.15mg/(kg.h)+氯胺酮0.04mg/(kg.h),MK2组接受吗啡0.15mg/(kg.h)+氯胺酮0.07mg/(kg.h)静脉术后镇痛治疗。分别于手术结束后6、12、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)。结果MK2组的疼痛评分在各时间点均明显低于M组和MK1组在相同时间点的疼痛评分(P<0.01),而M组和MK1组之间无统计学差异(P>0.05)。三组之间的镇静评分无统计学差异(P>0.05)。M组中恶心、呕吐、皮肤瘙痒(28.5%)明显高于MF2和MF1组,有统计学差异(P<0.05)。三组中均未出现具有精神症状的病例。结论小剂量氯胺酮[(0.07mg/(kg.h)]在妇科开腹患者静脉术后镇痛中能够增强吗啡的镇痛作用,减少吗啡的用量,减少副作用。

Objective To evaluate the effect and the side - effect of continuous intravenous infusion of low dose of ketamine combined with morphine for postoperative analgesia in patients undergoing abdominal Gynecological surgery, and determine the suitable dosage of ketamine. Methods 99 patients undergoing abdominal Gynecological surgery were randomly divided into three group s, i. e. Group M （morphine 0.02mgkg·h）, Group MK1（morphine 0.15 mgkg·h ＋ ketamine 0.04mgkg·h）, and Group MK2 （morphine 0.15 mgkg·h ＋ ketamine 0.07 mgkg·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 were recorded at 6,12,24,36,48 h after operation. Results The pain score of group MK2 at each time point was significantly lower than that of group M or group MK1（P〈 0.01 ） , and there was no significant difference between group M and group MK1 （ P 〉 0.05 ）. There were no sig-nify-cant difference among the three groups （ P 〉0.05） on sedation scores, with the incidence of the nausea and vomiting （ 18.5 %） and itching （7.4 %） were a significant higher in Group M （P 〉 0.05 ）. No case with central excitatory phenomena was found in each group. Conclusion 0.07 mgkg·h of ketamine can enhance the effect of morphine（0.15 mgkg·h）, lower the comsumpfion dosage of morphine, and decrease side-effect events.