小剂量氯胺酮复合帕瑞昔布钠多模式镇痛在妇科开腹手术中的应用

Clinical application of multimodal analgesia with a small dose of ketamine and parecoxib sodium in patients undergoing gynecological operation

目的 探讨小剂量氯胺酮复合帕瑞昔布钠多模式镇痛在妇科开腹手术中的应用效果.方法 将60例美国麻醉医师协会（ASA）Ⅰ～Ⅱ级择期行妇科开腹手术的患者完全随机分为3组：对照组、氯胺酮组、氯胺酮复合帕瑞昔布钠组,每组20例.患者均采用气管内插管全身麻醉,且术后应用静脉镇痛泵.氯胺酮组患者切皮前5 min静脉注射氯胺酮0.3 mg/kg;氯胺酮复合帕瑞昔布钠组患者插管后静脉注射帕瑞昔布钠0.8 mg/kg,并在切皮前5 min静脉注射氯胺酮0.3 mg/kg.采用视觉模拟评分法（VAS）评估患者术后1、6、12、24、48 h的疼痛感觉程度,观察患者术后镇痛泵有效触发次数以及恶心呕吐、皮肤瘙痒等不良反应的发生情况.结果 与对照组比较,氯胺酮组和氯胺酮复合帕瑞昔布钠组患者术后1、6、12、24、48 h VAS评分均降低[（2.06±0.48）、（1.94±0.30）分比（3.19±0.47）分；（2.79±0.23）、（2.75 ±0.93）分比（3.56 ±0.36）分；（2.80 ±0.20）、（2.74 ±0.23）分比（3.56 ±0.15）分；（1.33±0.17）,（1.11±0.26）分比（1.93±0.34）分；（1.00±0.16）、（0.84±0.13）分比（1.69±0.41）分]（均P＜0.05）,术后止痛泵有效触发次数明显减少（P＜0.05）.与氯胺酮组比较,氯胺酮复合帕瑞昔布钠组患者术后VAS评分及镇痛泵有效触发次数差异无统计学意义（P＞0.05）.3组患者术后恶心呕吐、皮肤瘙痒发生率比较差异无统计学意义（P＞0.05）.结论 妇科开腹手术术前静脉使用小剂量氯胺酮复合帕瑞昔布钠可以减轻患者的术后疼痛.

Objective To investigate the effects of multimodalanalgesia with a small dose of ketamine and parecoxib sodium on patients undergoing gynecological open operation.Methods Sixty patients （ASA Ⅰ-Ⅱ） undergoing elective gynecological open operation were randomly divided into three groups：control group （group N）,ketamine group （group K） and ketamine and parecoxib sodium group （group KP）.All patients were treated with general anesthesia and received patient-controlled intravenous analgesia （PCIA）.The patients in group K and group KP were injected with 0.3 mg/kg ketamine intravenously in 5 min before skin incision,while the patients in group KP received intravenous injection of 0.8 mg/kg parecoxib sodium immediately after tracheal intubation.The visual analog scale （VAS） was assessed at 1 h,6 h,12 h,24 h and 48 h after operation.The PCIA effective trigger number and the adverse reactions such as nausea,vomiting and itching were also investigated.Results The VAS at 1 h,6 h,12 h,24 h and 48 h after operation and the PCIA effective trigger number in group K and group KP was lower than that in group N （P 〈 0.05）.However,there were no significant difference between group K and group KP （P 〉 0.05）.There were not differences among three groups in adverse reactions such as nausea,vomiting and itching（P 〉 0.05）.Conclusion A small dose of ketamine and parecoxib sodium may relieve post-operation pain in patients undergoing gynecological open operation while there are less adverse reactions.