硬膜外—蛛网膜下腔麻醉中应用芬太尼和氯胺酮的临床观察

The Application of Fentanyl and Ketamine in Combined Spinal and Epidural Anesthesia

目的 :观察芬太尼、氯胺酮在硬膜外—蛛网膜下腔麻醉中的临床效果。方法 :80例择期行子宫手术的病人 ,随机分成 4组 (每组 2 0例 ) ,蛛网膜下腔分别加入 10 %葡萄糖溶液 (C组 )、芬太尼 2 0μg(F组 )、氯胺酮 10 m g(K组 )或芬太尼 2 0μg+氯胺酮 10 mg(F+ K组 )。在脊麻后及术中记录血压、心率、麻醉平面及牵拉反应情况 ;比较各组麻醉起效时间 (Ti)及维持时间 (Tm)。术终请外科医师和病人对麻醉情况行评分。结果 :K组 Ti 明显延长 ,但 Tm与 C组无明显变化 ;F组和 F+ K组的 Tm 明显延长 ,且 F+ K组牵拉反应发生率较 C组明显降低 (P <0 .0 5 )。外科医师和病人对麻醉评分各组无明显差异。结论 :硬膜外—蛛网膜下腔麻醉中伍用芬太尼或芬太尼和氯胺酮合剂可明显延长麻醉维持时间 ,而且后者能更好地防止术中牵拉反应的发生。

Objective:To observe the application of fentanyl and ketamine in combined spinal and epidural anesthesia. Methods:Eighty patients undergoing selective abdominal hysterectomy were assigned to one of four groups to receive 15 mg bupivacaine plus following drugs intrathecally. Group C received 10% glucose;Group F 20 microg fentanyl; Group K 10 mg ketamine; Group F+K 20 μg fentanyl plus 10 mg ketamine. BP, HR, sensory block level and the incidence of referred pain were recorded after spinal injection and during operation. The onset (T i) and the duration of action(T m) of anesthesia were also noted. Anesthesia was assessed by surgeons and visual analog scale(VAS) were assessed by patients. Results:In group K, T i was significantly prolonged (P<0.05)while T m showed little change. T m in both group F and group K+F were remarkably prolonged, and incidence of referred pain in group F+K decreased significantly (P<0.05). The assessments of surgeons and patients showed no significant differences. Conclusion:The application of fentanyl or fentany plus ketamine may prolong the duration of action, and the latter may inhibit the intraoperative referred pain better.