小剂量氯胺酮对瑞芬太尼麻醉后切口疼痛的影响

THE EFFECTS OF KETAMINE ON POSTOPERATIVE PAIN AFTER REMIFENTANIL ANESTHESIA

目的：观察不同剂量氯胺酮对瑞芬太尼麻醉后手术切口疼痛的影响。方法：选择年龄18-60岁,ASAⅠ-Ⅱ级,拟在全身麻醉下实行腹部手术的患者80例。随机分为4组,于麻醉诱导前分别静脉注射生理盐水5ml（Ⅰ组）、氯胺酮0.25mg·kg^-1（Ⅱ组）、0.50mg·kg^-1（Ⅲ组）、0.75mg·kg^-1（Ⅳ组）（稀释为5ml）。记录患者清醒拔管时、术后1h、2h、4h、6h、24h切口疼痛VAS（visual analogue scale/Score）评分,麻醉药的用量、麻醉时间、麻醉清醒时间,术后病人头疼、恶心、呕吐的发生情况。结果：Ⅳ组病人在拔管时、术后4h、6h、24h的VAS评分低于对照组（P〈0.05）,术后1h、2h的VAS评分与对照组比较无统计学意义（P〉0.05）;Ⅳ组病人术后6h的VAS评分低于Ⅱ组（P〈0.05）,术后24h的VAS评分低于Ⅱ、Ⅲ组（P〈0.05）;Ⅰ、Ⅱ、Ⅲ组组间各观察时点的VAS评分无统计学意义（P〉0.05）。麻醉药用量、麻醉时间、麻醉清醒时间,术后头疼、恶心、呕吐各组比较无统计学意义（P〉0.05）。结论：全麻诱导前静注0.75mg·kg^-1氯胺酮可降低瑞芬太尼使用后的痛觉过敏,而0.25mg·kg^-1、0.50mg·kg^-1氯胺酮对此没有显著影响。

Objective：To study the effects of different doses of ketamine on pain after remifentanil anesthesia. Methods Eighty patients aged from 18 to 60 years, ASA Ⅰ ～ Ⅱ ,undergoing major abdominal surgery under general anesthesia,were randomly divided into 4 groups, 20 cases in each group. Before induction, normal saline of 5ml（groupI） or ketamine （diluted to 5ml） 0.25mg·kg^-1（groupⅡ）, 0.50mg·kg^-1（groupⅢ）,0.75mg·kg^-1（groupⅣ） was injected intravenously, respectively. VAS （Visual Analogue Scale） score was recorded after extubation and 1h, 2h, 4h, 6h and 24h postoperatively. The amount of anethetics, anesthesia time, awake time, the incidence of headache, nausea and vomiting postoperatively were recorded.Results：Compared with the control group, the VAS score in patients in group Ⅳ significantly reduced at extubation, 4h, 6h and 24h postoperatively （P0.05）,no significance at 1h, 2h postoperatively（P0.05）.The VAS score in patients in group Ⅳat 6h decreased significantly than that of group Ⅱ（P0.05）.The VAS score in patients in group Ⅳ at 24h decreased significantly than that of group Ⅱ and Ⅲ （P0.05）.There was no significance in VAS scores among groupⅠ, Ⅱ,and Ⅲ （P0.05）.No significance was found in amount of anethetics, anesthesia time, awake time,the incidence of headache, nausea and vomiting postoperatively among all groups （P0.05）.Conclusion： Injection with 0.75mg·kg^-1 ketamine before anesthesia could reduce the postoperative hyperalgesia after the use of remifentanil. 0.25 and 0.50mg·kg^-1 ketamine had no obvious effect on preventing this hyperalgesia.