小剂量氯胺酮对舒芬太尼皮下镇痛效果的影响

Effects of low-dose ketamine on patient-controlled subcutaneous analgesia with sufentanil

目的 评价小剂量氯胺酮对舒芬太尼皮下镇痛效果的影响.方法 行腰椎内固定术患者200例,随机分为4组：对照组（SF组）和试验组（SK1、SK2、SK3组）.术毕即刻分别持续皮下输注舒芬太尼0.5 ng·kg-1·min-1＋氯胺酮0、0.5、1.0、2.0 ug·kg^-1·min^-1.比较术后舒芬太尼用量、VAS评分及不良反应.结果 SK1、SK2、SK3组患者术后各时间VAS评分均低于SF组（P〈O.05或P〈0.01）,且SK3组低于SK1、SK2组（P〈0.01）,SK2组亦低于SK1组（P〈0.01）.SK2、SK3组在术后不同时段舒芬太尼用量均低于SF、SK1组,且SK3组低于SK2组（P〈0.01）.SK3组发生嗜睡、做梦、复视等精神副作用发生率高于其他3组（P〈0.05）.结论 小剂量氯胺酮能够增强术后舒芬太尼皮下镇痛的效果,降低舒芬太尼需求量.推荐氯胺酮辅助舒芬太尼皮下镇痛的剂量以0.5～1.0 ug·kg^-1·min^-1为宜.

Objective To investigate the effects of low-dose ketamine on patient-controlled subcutaneous analgesia with sufentanil. Methods Two hundred patients with operation of lumbar vertebrae internal fixation were received patient-controlled subcutaneous analgesia with sufentanil and ketamine after anesthesia disappeared. Patients were randomly divided into four groups： group SF （received sufentanil 0. 5ng·kg^-1·min^-1） and group SK1, SK2, SK3 （received sufentanil 0.5 ug·kg^-1·min^-1 and ket amine 0.5, 1.0, 2.0 ug·kg^-1·min^-1 respectively）. The dosage of sufentanil, VAS, and the adverse reactions were recorded after operation. Results Compared with group SF, VAS was lower in the SK groups after operation （P〈0.05 or P〈0.01）. There was a significant difference in VAS among group SK1, SK2 and SK3 （P%0.01）. The dosages of sufentanil in group SK2 and SK3 were less than that in group SK1 and SF, and that in group SK3 was the least （P〈0.01）. The incidence of spiritual side effects including drowsiness, dreaming, diplopia and illusion was the highest （P〈 0.05） in group SK3. Conclusion Low-dose ketamine can enhance the postoperative analgesic effect of subcutaneous sufentanil in a dose-depen dosage of ketamine 0.5- 1.0 ug·kg^-1·min^-1