全麻开胸手术前静注氯胺酮对术后痛的影响

INJECTION OF KETAMINE BEFORE THORACIC OPERATION REDUCES POST-OPERATIVE PAIN

目的 :观察开胸手术切皮前静注氯胺酮对术后痛的影响。方法 :36例ASAⅠ～Ⅱ级食管癌择期手术患者 ,随机分成两组 ,K组为氯胺酮组 ,C组为对照组。术前不用阿片类药物。麻醉诱导静注异丙酚 (2mg/kg)、司可林 (1～ 1.5mg/kg) ,气管插管机械通气。K组于切皮前 10分钟静注氯胺酮 1mg/kg(5ml溶液 ) ,C组切皮前 10分钟静注生理盐水 5ml。术中静滴异丙酚和吸入安氟醚维持麻醉 ,间断静注维库溴铵保持肌松。术后患者完全清醒后拔除气管导管送回病房。采用VAS法评价术后疼痛 ,当VAS≥ 6分时 ,给患者肌注杜冷丁 5 0mg。比较两组术后 0～ 4h、4～ 8h、8～ 12h、12～ 16h、16～ 2 0h、2 0～ 2 4h各时段肌注度冷丁人数及度冷丁平均用量。结果 :K组前 16h各时段肌注度冷丁人数显著少于C组 (P 0 .0 5 )。K组术后 2 4h度冷丁平均用量显著少于C组 (P 0 .0 5 ) ,但主要集中在前 16小时各时段 ,其后各时段两组无显著差异。结论 :开胸手术切皮前静注氯胺酮能显著降低术后痛。

Objective: To observe the effect of intravenous injection of ketamine before thoracic operation on the extent of post operative pain. Methods: 36 adult ASA grade Ⅰ～Ⅱ patients undergoing thoracic operation were randomly divided into two groups receiving intravenous ketamine 1mg/kg in a 5ml saline (ketamine group, n=18) or 5ml saline(Control group, n=18) 10min before skin incision. The post operative pain was measured by visual analogoue scale. When the VAS was over 6, the patients were injectived intramusculary dolantin 50mg. The average dose of dolantin needed and the number of patients receiving intramuscularly injection of dolantin in the 2 groups 0～4h, 4～8h, 8～12h, 12～16h, 16～20h, 20～24h after operation. Results: Average quantity of dolantin used in Group C were heighter than group K ( P <0.05), the number of patients receiving intramuscular dolantin in group C were also heighter than group K( P <0.05). Conclusion: Ketamine for patients undergoing thoracic operation can reduce post operative pain.