氯胺酮预处理预防雷米芬太尼苏醒期躁动的效果

Effect of ketamine-pretreatment on the restlessness during emergence from remifentanil-based general anesthesia

目的探讨氯胺酮预处理预防雷米芬太尼麻醉苏醒期躁动的效果。方法鼻窦镜手术患者60例均分为两组,采用相同的全凭静脉复合麻醉。E组麻醉诱导前静注氯胺酮0.5mg/kg,C组不用氯胺酮作为对照。记录停药拔管后20min内的躁动评分(RS)、视觉模拟疼痛评分(VAS)和警觉/镇静评分(OAA/S)。同时测定血浆皮质醇(Cor)、肾上腺素(E)和去甲肾上腺素(NE)水平。结果 E组拔管后20min内的RS和VAS评分以及血浆Cor、E和NE水平均明显低于C组(P<0.05);但两组OAA/S评分无明显差异。结论小剂量氯胺酮预处理可以预防雷米芬太尼麻醉苏醒期躁动,减轻应激反应,减少痛觉高敏,但对意识和呼吸无影响。

Objective To investigate the preventive effect of ketamine-pretreatment on the restlessness during emergence from remifentanil-based general anesthesia.Methods Sixty patients undergoing function endoscopic sinus surgery under remifentanil-based general anesthesia were equally randomized into two groups of E（ketamine 0.5 mg/kg injected before induction） and C（without ketamine）.The restlessness score（RS）,VAS pain score,and OAA/S sedation score were recorded during extubation.Plasma cortisol（Cor）,epinephrine（E） and norepinephrine（NE） were measured at the same time.Results The scores of RS and VAS as well as plasma levels of Cor,E and NE were all lower in group E than those in group C（P0.05）.But OAA/S sedation score was not significantly different between two groups.Conclusion The pretreatment with low dose of ketamine can prevent the restlessness during emergence from remifentanil-based general anesthesia without any influence on the recovery of consciousness and respiration.