小量氯胺酮复合舒芬太尼用于下肢骨折术后患者静脉镇痛的疗效和安全性观察

The Analgesic Effect and Safety of Continuous Intravenous Infusion of Small Dose of Ketamine Combined with Sufentanyl for Postoperative Patients of Lower Limb Fracture

目的观察小量氯胺酮复合舒芬太尼用于下肢骨折术后患者静脉自控镇痛的临床效果及安全性。方法将60例下肢骨折拟行内固定手术患者随机分成2组,实验组(氯胺酮舒芬太尼)和对照组(舒芬太尼),每组30例,均以一次性镇痛泵(2 mL/h共50h)行静脉术后镇痛。实验组舒芬太尼0.35μg/(kg.h)+氯胺酮35μg/(kg.h),对照组舒芬太尼0.5μg/(kg.h)静脉术后镇痛治疗。记录疼痛、发生的不良反应(瘙痒、恶心呕吐、精神症状)、血氧饱和度。结果实验组的疼痛评分在各时间点均明显低于对照组。两组中对照组恶心、呕吐的发生率较高,两组之间差异有统计学意义。皮肤瘙痒和尿潴留两组之间差异无统计学差异。两组的血氧饱和度值在各时间点均不低于96%,而且两组之间差异无统计学意义,两组均未出现精神症状。结论 35μg/(kg.h)氯胺酮在静脉术后镇痛中能够增强舒芬太尼0.35μg/(kg.h)的镇痛作用,而且不增加副作用。

Objective To observe the analgesic effect and safety of continuous intravenous infusion of small dose of ketamine combined with sufentanyl for postoperative patients of lower limb fracture. Methods 60 postoperative patients were randomly divided into two groups with 30 cases each. Intravenous postoperative analgesia was administered to experiment group （sufentanyl 0.35μg/kg·h ＋ ketamine 35μg/kg·h）, control group （sufentanyl 0.5 μg/kg·h）. The parameters, such as pain score of VAS, incidence of side effect including itch, nausea, vomiting and central excitatory phenomena, and SpO2 were recorded respectively at 12, 24, and 48 hours after operation. Results The pain score of E Group at each time point was significantly lower than that of C Group. There were significant differences in the incidence of nausea, vomiting. No significant differences in itching and urine retention among these groups. No case with central excitatory phenomena was found in each group. At each time point, no significant difference in SpO2 was found among the two groups, and all the SpO2 values were not less than 96%. Conclusion Ketamine at 35 g/kg·h can enhance the efficacy of sufentanyl （0.35g/kg·h） without increasing side effect events.