摘要
目的观察小剂量NMDA受体拮抗剂氯胺酮复合芬太尼和氯诺昔康皮下镇痛(PCSA)的安全性和有效性。方法择期在全麻下行椎弓根钉内固定术患者60例,ASAⅠ~Ⅱ级,术中均用丙泊酚+瑞芬太尼维持麻醉,术后镇痛按药物配伍不同随机分为3组(n:20):A组芬太尼0.01mg/ks+氯诺昔康0.6mg/kg;B组氯胺酮2ms/kg+芬太尼0.01mg/kg+氯诺昔康0.6mg/kg;C组芬太尼0.02mg/kg+氯诺昔康0.6mg/kg。氯诺昔康用无菌用水稀释,然后用0.9%生理盐水配制成混合药液100mL。应用PCA泵,3组术后经皮镇痛均采用负荷量+持续背景量+PCA量模式:负荷剂量3mL,背景剂量2mL/h,PCA剂量0.5mL,锁定时间15min。观察术后4h(T1)、8h(T2)、16h(T3)、24h(T4)、48h(T5)各时点视觉模拟评分(VAS)、Ramsay镇静评分、血压(BP)、心率(HR)、脉搏血氧饱和度(SpO2)、呼吸频率(RR)和患者对PCA综合满意度及不良反应。结果3组患者镇痛效果均良好,在术后镇痛T1时点静息和活动时VAS评分B组和C组均小于A组,差异有显著性(P〈0.05)。B组和C组的PCA综合满意度为优的例数显著多于A组(P〈0.05)。3组术后各时点BP,HR,RR,SpO2均在正常范围内波动,差异无显著性(P〉0.05)。各组不良反应发生率较低且差异无显著性(P〉0.05)。结论瑞芬太尼全麻患者应用小剂量氯胺酮复合芬太尼和氯诺昔康皮下术后镇痛安全、有效,且不良反应少。
Objective To investigate the efficacy and safety of patient controlled subcutaneous analgesia (PCSA) with low dose NMDA - receptor antagonist ketamine combined with fentanyl and Lornoxicam. Methods Sixty patients, aged 30 - 59, weighed 45 - 78 kg, with ASA grade Ⅰ - Ⅱ, undergoing transpedicular screw fixation, were randomly allocated to group A, B or C each with 20 patients. The drug combination consisted of fentanyl 0.01 mg/kg with Loruoxicam 0.6 mg/kg in group A, ketamine 2 mg/kg with fentanyl 0. 02 mg/kg and Lornoxicam 0.6 mg/kg in group B, fentanyl 0. 02 mg/kg with Lomoxicam 0.6 mg/kg in group C. Loruoxicam was diluted with sterile water and prepared with normal saline. Patient controlled subcutaneous analgesia was set at loading dose of 3 mL, background infusion of 2 mL/h, bolus dose of 0.5 mL, and lockout interval of 15 minutes. The Visual Analogue Scale, Ramsay sedation score, BP, HR, SpO2 and RR were recorded at 4 (T1 ), 8 (T2 ), 16 (T3 ), 24 (T4) and 48 h ( T5 ) after operation. The overall patient satisfaction with PCA was evaluated. Adverse effects were also recorded. Results The effect of analgesia was satisfactory in all groups. The VAS of group B and C was significantly lower than that in group A at T1 ( P 〈 0.05 ). The overall patient satisfaction of PCA in Group B and C was better than that in group A ( P 〈 0.05 ). The HR, MAP, RR and SpO2 of all groups fluctuated in normal limits( P 〉 0.05 ). The incidence of adverse effects was low and similar in all groups ( P 〉 0. 05 ). Conclusion PCSA with low dose ketamine combined with fentanyl and Lomoxicam was safe and effective with few adverse effects in patients after general anesthesia with remifentanil.
出处
《广东医学》
CAS
CSCD
北大核心
2009年第7期1055-1057,共3页
Guangdong Medical Journal
基金
广东省科技计划项目(编号:200883025)
关键词
氯胺酮
镇痛
皮下
瑞芬太尼
氯诺昔康
ketamine
analgesia
subcutaneous
remifentanil
lornoxicam