氯胺酮对肺癌开胸术后患者舒芬太尼静脉镇痛效应的影响

Effects of Ketamine on intravenous patient-controlled analgesia with Sufentanil in patients suffering primary lung cancer after thoracic surgery

目的:观察氯胺酮对肺癌开胸术后患者舒芬太尼静脉自控镇痛效应的影响。方法:肺癌择期开胸手术患者45例,男33例,女12例,年龄45～70岁,体重47～71kg,根据氯胺酮持续输注的剂量随机分为三组,Ⅰ组为对照组持续输注等容量生理盐水,Ⅱ、Ⅲ组于切皮后分别输注氯胺酮42μg/(kg·h)和83μg/(kg·h),至术后24h镇痛结束。缝皮后经颈内静脉接施曼信电子镇痛泵(内含用生理盐水稀释至100ml的舒芬太尼250μg),参数设定为负荷剂量5μg,背景剂量1μg/h,PCA追加剂量2.5μg,锁定时间3min。术后患者诉疼痛后视觉模拟评分(VAS)>0,开机镇痛,记录开机给负荷量后0、4、8、16、20、24h等时间点舒芬太尼的累积用量、按压次数(D1)、实进次数(D2)、BP、HR、RR、SpO2、VAS、Ramsay评分和不良反应及治疗措施。结果:术后0、4h等时间点VAS评分、D1和D2,Ⅰ组高于Ⅱ组和Ⅲ组,且呈下降趋势(P<0.05～0.01)。Ⅰ组24h舒芬太尼累积用量为(167.5±40.5)μg多于Ⅱ组和Ⅲ组(P<0.01),Ⅱ组(135.6±25.6)μg多于Ⅲ组(100.6±13.8)μg(P<0.01)。两组不良反应发生率比较,差异无统计学意义,P>0.05。总体满意度(GSS≤2),Ⅰ组11例(53.3%),少于Ⅱ组12例(80%)和Ⅲ组15例(100%),P<0.01。结论:持续输注小剂量氯胺酮可减少肺癌开胸手术后舒芬太尼静脉镇痛用量,不良反应低,可提高患者镇痛满意度。

Objective： To investigate the effects of ketamine on intravenous patient-controlled analgesia with sufentanil in patients suffering primary lung cancer after thoracic surgery. Methods： 45 patients consisted of 33 males and 12 female, aged 45-70, weight 47-71 kg ,after thoracic surgery were randomly divided into three groups equally,patients in group Ⅰ received normal saline as control group, patients in group Ⅱ received ketamine at a rate of 42 μg/（kg. h） and in group Ⅲ received at 83 μg/（kg.h）,from incision to postoperative 24 hours. PCEA with sufentanil.A mixture of sufentanil 250 μg diluted with 0.9% normal saline 100 ml was loaded in Smith electronic PCA pump.The PCA device was set to be a loading dose of sufentanil 5 μg, a bolus PCA dose of sufentanil 2.5 μg, a background infusion dose of 1 μg/h, a lockout interval of 3 min. When patients complainted of wound pain （VAS〉0）, sufentanil was given with a PCA pump. Culminative sufentanil consumption, Demands and deliveries of PCA, BP, HR, RR, SpO2, pain and sedation assessed at rest with visual analog scale （VAS） and the Ramsay sedation score were recorded or performed at 0,4,8,16,20,24 h after administeration of loading dos of sufentanil. Side-effects, such as postoperative nausea and vomiting （PONV）, pruritus,dysphoria and somnolenc were also recorded during the first 48 h after surgery. Results： VAS assessed for pain in group Ⅰ was higher than those in group Ⅱ and group Ⅲ at 0,4 hours time points （P〈0.05 -0.01）. Cumulative sufentanil consumption in group Ⅰ during postoperative 24 h after surgery was （167.5±40.5） μg,which was significantly more than （135.6±25.6） μg in group Ⅱ and （100.6±13.8） μg in group Ⅲ （P〈0 .01）The incidence of side-effects was low and similar in the two groups,but patients in group Ⅱ and groupⅢ with global satisfactory score ≤ 2 were more than those in group Ⅰ. Conclusion： Continuous infusion of low-dose ketamine deduced sufentanil consumption after thoracic surgery and achieved a low incidence of side-effects and a higher global satisfactory score.