小剂量氯胺酮对老年患者瑞芬太尼麻醉术后镇痛的影响

Effect of Small-dose of Ketamine on the Postoperative Analgesia after Remifentanil Anesthesia in Elder Patients

目的 探讨小剂量氯胺酮对老年患者瑞芬太尼麻醉术后镇痛的影响.方法 选择60例拟在全身麻醉下行腹部大手术的老年患者,随机分为（每组30例）对照组、研究组.两组患者均静脉注射咪唑安定、丙泊酚、瑞芬太尼、维库溴铵麻醉诱导.术中持续输注瑞芬太尼0.3μg·kg^-1·min^-1、维库溴铵2μg·kg^-1·min^-1和吸入七氟醚维持麻醉.研究组在麻醉诱导时给予0.5mg/kg氯胺酮,后持续输注5μg·kg^-1·min^-1.对照组给予等量生理盐水输注.手术结束时停止瑞芬太尼、氯胺酮输注.手术结束前30min静脉给予芬太尼1μg·kg-1.记录术后患者睁眼时间、拔管时间,行芬太尼静脉PCA,记录术后1h,3h,6h,12h,24h时间点的VAS评价疼痛强度和芬太尼累积用量,观察不良精神反应.结果两组患者的睁眼、拔管时间、不良精神反应发生率无统计学意义.各时点研究组术后芬太尼的用量显著低于对照组（P＜0.05）.VAS评分：研究组术后各时点的VAS评分显著低于观察组（P＜0.05）.结论 小剂量氯胺酮可以有效减少老年患者瑞芬太尼麻醉术后芬太尼的用量,提高镇痛质量,可能与氯胺酮能够预防老年患者瑞芬太尼麻醉后的急性阿片耐受或痛觉过敏有关.

Objective To investigate the effect of small-dose dose of ketamine on the postoperative pain after remifentanil aislesthesia in elder patients. Methods Sixty ehler patients undergoing major, abdominal surgery were randomly divided into two groups（ n = 30 each ） ：study group and control group. Anesthesia was induced with midazolam, propotbl, renlifentanil, vecuronium and maintained with vecuronium at 2μg·kg-1·min^-1 remifentauil at 0.3μg·kg^-1·min^-1 and sevoflurane inhalalion during operation. In study group patients were given ketamine 0.5mg/kg for induction and 5μg·kg^-1·min^-1 . rain I during operation. The time of open-eyes and extuhation were recorded. Patients received patient-controlled analgesia with fentanyl for 24h post-uperatively. The visual analogue scale（ VAS）scores, fentanyl consumption,side-effects were recorded during the first 24h post-operatively. Results There were no significant difl＇erent＇es in the lime of open-eyes and extuhation and side-effects in two groups. The postoperative consumption in control group C were significantly more Ihan those in study gruup at 1,3,6,12,24h after operation. The VAS scores in study group were less than those in control group at 1 ,3,6,12,24h after operalion. Conclusion The additional small-dose ketamine can reduce the fentanyl consumption and the VAS scores of postoperation pain after remifentanil anesthesia. It suggest that ketamine can prevented remifentanil-indueed hyperalgesia or acute opiold tolerance in elder patients.