小剂量氯胺酮对下肢骨折术后芬太尼静脉自控镇痛效果的影响

Effect of Low Dose Ketamine on Patient-controlled Intravenous Analgesia with Fentanyl after Lower Limb Fracture Surgery

目的观察小剂量氯胺酮对下肢骨折术后芬太尼静脉自控镇痛(PCIA)效果的影响和不良反应。方法将58例急诊下肢骨折病人随机分入氯胺酮复合芬太尼组(KF组)和芬太尼组(F组),每组29例。术后行PCIA:负荷剂量(0.1ml/kg)+持续背景剂量(2 ml/h)+自控镇痛(PCA)(2 ml/次),锁定时间15 min。镇痛泵配方:KF组,氯胺酮3 mg/kg+芬太尼20μg/kg+氟哌利多5 mg;F组,芬太尼20μg/kg+氟哌利多5 mg。均用0.9%氯化钠溶液稀释至100 ml。记录镇痛期间患者循环、呼吸情况;术后8、12、24、48 h进行视觉模拟评分法(VAS)评分、镇静评分、PCA按压次数、镇痛满意度、48h内恶心、皮肤搔痒、精神症状的发生率。结果镇痛期间两组患者循环、呼吸稳定,组间比较,差异无统计学意义(P>0.05);术后4、8、12、24、48 h KF组VAS评分、PCA按压次数均低于F组,组间比较,差异均有统计学意义(P<0.05);两组间镇静评分无统计学差异(P>0.05);KF组镇痛满意度优于F组(P<0.05);48 h内总体不良反应发生率,两组间比较无统计学差异(P>0.05)。结论小剂量氯胺酮能增强下肢骨折病人术后芬太尼静脉自控镇痛的效果,增加镇痛满意度,不增加不良反应。

[Objective]To observe the effect and adverse reactions of low dose ketamine on patient-controlled intravenous analgesia（PCIA） with fentanyl after lower limb fracture surgery.[Methods]58 emergency patients with lower limb fracture were randomly divided into the ketamine combined with fentanyl（KF） group and the fentanyl（F） group with 29 cases in each group.The patients were treated with PCIA：loading dose 0.1ml/kg,background dose 2 ml/h,patient-controlled analgesia（PCA） 2 ml /time,lockout-time 15min.The KF group was given ketamine 3 mg/kg ＋ fentanyl 20μg /kg ＋ droperidol 5mg,the F group was given fentanyl 20μg /kg ＋droperidol 5mg,and drugs were diluted to 100 ml with 0.9% saline for both group.The status of circulatory system and respiratory system of patients during PCIA,VAS scores,sedation score,PCA demand times and satisfactory of analgesia at 8,12,24 and 48 h after surgery,the incidence of nausea,pruritus and mental symptoms at 48 h after surgery were observed.[Results]During PCIA,the circulatory system and respiratory system of patients was stable,and there was no significant difference between two groups（P0.05）.The VAS scores and PCA demand times at 8,12,24 and 48 h after surgery of KF group were significantly lower than that of F group（P0.05）.There was no significant difference in sedation score between two groups（P0.05）.The satisfactory of analgesia in KF group was significantly higher than that in F group（P0.05）.There was no significant difference in total incidence of adverse reactions within 24h between two groups（P0.05）.[Conclusion]Low dose ketamine can strengthen the effect of fentanyl PCIA after lower limb fracture surgery,improve the satisfactory of analgesia,and the adverse reactions have not increased.