小剂量氯胺酮—吗啡配伍硬膜外腔术后镇痛的临床观察

Clinical Observation on Analgesic Effect of Small Dosage Compatibity of Chloramineton and Morphine Injected into External Meningocavite

目的：观察小剂量氯胺酮—吗啡配伍用于硬膜外术后镇痛效应及对吗啡副反应的影响。方法：选择我院硬膜外麻醉下行胆囊切除术患者４５ 例，ＡＳＡＩ级，随机分为三组，每组１５ 例，术毕经硬膜外导管分别注入Ⅰ组：氯胺酮０ ．５ｍｇ·ｋｇ－ １ ：Ⅱ组：吗啡０ ．０３ｍｇ·ｋｇ－ １ ：Ⅲ组：氯胺酮０ ．４ｍｇ·ｋｇ－ １ ，吗啡０ ．０２ｍｇ·ｋｇ － １ ，于术后４ 、８ 、１２ 、２４ 、４８ 、７２ 小时记录镇痛效果及副反应发生情况，监测呼吸频率（ＲＲ） ，脉搏血氧饱和度（ＳＰＯ２） 对比分析。结果：Ⅰ组术后一级镇痛时间为８ ．１３ ±２ ．１６ 小时，明显短于Ⅱ组为３６ ．１５ ±３ ．６０ 小时（ Ｐ＜ ０ ．０１） ，Ⅲ组一级镇痛时间为４２ ．１５ ±３ ．２５ 小时，明显长于Ⅰ、Ⅱ组（ Ｐ＜ ０ ．０１） ，Ⅲ组有效镇痛时间为４８ ．２６ ±４ ．０２ ，明显长于Ⅰ、Ⅱ组，分别为１３ ．１８ ±５ ．０７小时和４２ ．３７ ±５ ．１３ 小时（ Ｐ＜ ０ ．０１） 。三组尿潴留发生率比较，Ⅰ、Ⅲ组分别为０ 和６ ％ ，明显低于Ⅱ组为１０ ％ （ Ｐ＜ ０ ．０１） ，恶心呕吐发生率Ⅱ组为９ ％ ，明显高于Ⅰ、Ⅲ组均为４ ％ （ Ｐ＜ ０ ．０１） ；各组各观察点ＲＲ、ＳＰＯ２ 比较?

s Objective:To survey the analgesic effect of small dosage compatibility of chloramineton and morphine injected into external meningocavite after operation and monitor side effect of morphine. Methods:45 cases of cholecystectomy anaesthetized at external meningocavite were chosen. They were divided into three groups. 15 cases a group. While finished the operation the medicine were injected into external meningocavite through the duct. Ⅰ group:chloramineton 0.5mg/kg,Ⅱ group:morphine 0.03mg/kg, Ⅲ group:chloramineton 0.4mg/kg. morphine 0.02mg/kg. Observated the analgesic effect and the side effect of medicine monitored the respiratory rate(RR). The pulse and SPO 2.Results:The grade Ⅰ analgesic time of Ⅰ group were 18.13±2.16 hours. It were obviously shorter than Ⅱ group (36.15±3.6hours)( P <0.01). In Ⅲ group the grade Ⅰ and effective analgesic time were respectively 42.15±3.25 and 48.26±4.02 hours. It were significative longer than Ⅰ、Ⅱ groups ( P <0.01) (13.18±5.07/Ⅰ group, 42.37±5.13/Ⅱ group). The rate of uroschesis in Ⅰ and Ⅲ groups 0 and 6%. lower than Ⅱ group(10%/Ⅱ group)( P <0.01) (13.18±5.07/Ⅰ group, 42.37±5.13/Ⅱ group). The rate of uroschesis in Ⅰ and Ⅲ groups( P <0.01). The rate of nausca and vomit of Ⅱ group were 9% which much higher than Ⅰ、Ⅲ groups (4%Ⅰ、Ⅲ group)( P <0.01).The RR and SPO 2of three groups had no significative difference ( P >0.05).Conclution:The analgesic time of small dosage compatibility of chloramineton and morphine were longer than that routine dosage of single chloramineton or morphine after operation and it can decrease the uroschesis and vomit and side effect of morphine.