低剂量氯胺酮超前镇痛应用于开胸手术的临床研究

Preemptive analgesia by intravenous low-dose Ketamine in elective thoractomy

目的探讨开胸手术应用低剂量氯胺酮的效果及副作用。方法 60例择期开胸手术患者按随机、双盲原则分为对照组和氯胺酮组各30例。氯胺酮组切皮前5 min静脉注射氯胺酮0.15 mg/kg,后持续泵注氯胺酮0.2 mg/(kg.h)至手术结束;对照组相应静脉注射和泵注生理盐水,术后经静脉患者自控镇痛(PCIA)。分别于术后72小时内各时间点观察患者的视觉模拟评分(VAS评分),记录PCA泵总按压次数、有效按压次数及曲马多用量与副作用。术后电话随访疼痛情况,了解慢性疼痛发生率。结果术后各时间点VAS评分差异无统计学意义(P>0.05);氯胺酮组PCA泵总按压次数、有效按压次数及曲马多用量较对照组少(P<0.05);术后电话随访两组慢性疼痛发生率差异无统计学意义(P>0.05)。苏醒期躁动、谵妄、恐惧、噩梦等不良精神反应和其他不良反应的发生情况,两组比较差异无统计学意义(P>0.05)。结论开胸手术给予低剂量氯胺酮,可以减少术后镇痛药的用量,但不能减少术后慢性疼痛发生率,氯胺酮超前镇痛的确切性仍有待研究。

Objective To evaluate the effects preemptive analgesia by intravenous low-dose ketamine in elective thoractomy. Methods Sixty patients undergoing elective thoractomy under general anesthesia were randomly divided into 2 groups：The ketamine group and control group. The ketamine group received ketamine 1.5 mg/kg i. v 5 min before skin incision and 0.2mg/（ kg h） for ma- intenance during operation. The control group received equal volume of normal saline as the ketamine control. All patients received post- operative PCIA. Visual analogue scale （VAS） scores at rest and movement, PCA press times, ratio of PCA press times （ effective/ actual ）, cumulative volumes of tramadol and side-effect were assessed within 72 hours. The incidence of chronic post-operative pain were evaluated at 3,6,and 12 months after surgery by pHone call. Results There were no statistically significant difference of VAS scores（P 〉 0.05）. PCA press times The ratio of PCA press times（ effective/actual ） and cumulative volumes of tramadol were signifi- cantly lower in ketamine group than that in control group （P 〈 0.05）. There was no difference in the incidence of chronic post-opera- tive pain between the 2 groups （ P〉 0.05 ）. Conclusion Preemptive analgesia only by intravenous low-dose ketamine in elective thoractomy can decreas dosage of analgesic after operation, but did not show any beneficial effects in preventing chronic post-operative pain.