小剂量氯胺酮减轻烧伤切痂植皮术中瑞芬太尼所致痛觉过敏的效应

Effect of low dose ketamine on remifentanil-induced hyperalgesia in burn patients undergoing escharectomy and skin grafting

目的 观察小剂量氯胺酮对烧伤切痂植皮术中瑞芬太尼所致痛觉过敏（opioid-induced hyperalgesia,OIH）的影响.方法 选取2013年6-12月在解放军总医院第一附属医院烧伤科行切痂植皮手术的患者60例,年龄18～ 60岁,ASA Ⅰ～Ⅱ级,受区面积1％～30％,所有患者均使用七氟烷吸入、4 ng/ml靶控输注瑞芬太尼维持麻醉.患者随机分为两组,氯胺酮组（n＝30）麻醉诱导开始时给予0.3 mg/kg负荷量,之后以3μg/（kg·min）持续输注至手术结束;对照组（n=30）注射等剂量的0.9％氯化钠注射液,比较两组术中生命体征、术后7h内视觉模拟评分（visual analogue scale,VAS）及通过病人自控镇痛泵（patientcontrolled analgesia pump,PCA）输注的吗啡用量.结果 氯胺酮组术后3h内VAS评分、2h内吗啡用量均低于对照组（P＜0.05）.结论 当在烧伤切痂植皮手术中以瑞芬太尼作为麻醉性镇痛药时,术中持续输注小剂量氯胺酮有助于减轻瑞芬太尼所致术后痛觉过敏,减少阿片类药物的用量.

Objective To study the effect of low-dose ketamine on remifentanil-induced hyperalgesia in bum patients undergoing escharectomy and skin grafting.Methods Sixty ASA Ⅰ-Ⅱ burn patients aged 18-60 years who underwent escharectomy and skin grafting in First Affiliated Hospital of Chinese PLA General Hospital from June 2013 to December 2013 were enrolled in this study.The patients had a recipient area of 1%-30% and were anesthetized with sevofurane and 4 ng/ml remifentanil,and they were randomly divided into ketamine group and control group （30 in each group）.The patients in ketamine group were injected with ketamine （0.3 mg/kg） followed by remifentanil [3 μ g/（kg · min）] till the end of surgery,while those in control group were injected with an equal amount of 0.9% sodium chloride.Their intraoperative vital signs,visual analogue scale （VAS） score and morphine used through the patient controlled analgesia （PCA） pump 7 h after operation were compared.Results The VAS score within 3 h after operation and morphine used within 2 h after operation were signifcantly lower in ketamine group than in control group （P 〈 0.05）.Conclusion Continuous infusion of low dose ketamine can decrease the remifentanil-induced hyperalgesia and the use of opioid in burn patients undergoing escharectomy and skin grafting.