小剂量氯胺酮对合并呼吸道烧伤病人术后芬太尼自控静脉镇痛效果的影响

Effects of Low-dose Ketamine on Efficacy of PCIA with Fentanil after Surgery In Burn Patients with Respiratory Paths

目的探讨小剂量氯胺酮对合并呼吸道烧伤病人术后芬太尼自控静脉镇痛（PCIA）的临床效果和安全性。方法择期拟行切痂植皮烧伤手术病人50例,年龄20~45岁,ASAⅠ或Ⅱ级,随机分为2组（n=25）,I组芬太尼15μg.kg-1和Ⅱ组芬太尼15μg.kg-1＋氯胺酮100mg,两组镇痛药物均加入恩丹西酮8mg,并用生理盐水稀释至100mL。镇痛泵参数设置为背景输注速率2mL.h-1,按压单次给药剂量0.5mL,锁定时间15min。于术毕静脉连接镇痛泵。记录两组病人术后48 h内血压（BP）、心率（HR）、脉搏血氧饱和度（SpO2）和镇痛评分,观察恶心呕吐、皮肤瘙痒、尿潴留、幻觉和呼吸抑制不良反应的发生情况。结果两组病人BP、HR和SpO2差异无统计学意义（P〉0.05）;与I组比较,Ⅱ组镇痛评分降低（P〈0.05）,Ⅱ组恶心呕吐、皮肤瘙痒和尿潴留发生率降低（P〈0.05）;两组均无幻觉及呼吸抑制发生。结论小剂量氯胺酮联合芬太尼在合并呼吸道烧伤病人中镇痛效果较单纯芬太尼效果好。

Objective To evaluate the effects of low-dose ketamine on the efficacy of intravenous PCA（PCIA） with fentanil after surgery in burn patients with respiratory paths.Methods Fifty ASAⅠorⅡburn patients with respiratory paths aged 20~45 yr undergoing elective surgery under general anesthesia were randomized into 2 groups（n=25 each） according to the composition of solution： group I fentanil 15μg/kg;group Ⅱ fentanil 15μg/kg ＋ ketamine 100mg.8mg of ondansetron was added to each recipe,and then diluted into 100mL with normal saline.The PCIA setting was as follows： background infusion 2mL/h,bolus dose 0.5 mL,lockout interval 15 min.The PCIA was given at the end of operation.Blood pressure（BP）,respiration rate（HR） and pulse O2 saturation（SpO2） were monitored within 48 h after operation.Analgesia scores were record.Complications incluing nausea and vomiting and pruritus and uroschesis and hallucination and respiratory depression were recorded.Results BP,HR and SpO2 showed no significant change between the two groups.Compared with group I,Analgesia scores wre significantly decreased in group Ⅱ（P0.05）.The incidence of nausea,vomiting,d pruritus and uroschesis in group Ⅱ was significantly lower than those in Group I（P0.05）.There was no hallucination and respiratory depression between the two groups.Conclusion Low-dose ketamine can improve the efficacy of PCIA with fentanil after surgery in burn patients with respiratory paths with lower adverse effects.