用氯胺酮抑制颌面外科手术瑞芬太尼麻醉后痛觉过敏的临床研究

Effects of small-dose ketamine on the patients with postoperative hyperalgesia induced by remifentanil-based anaesthesia in oral and maxillofacial surgery

目的评价应用小剂量氯胺酮缓解颌面部手术瑞芬太尼麻醉后痛觉过敏的有效性和安全性。方法择期全麻下颌面部手术患者80例,随机分为氯胺酮组(n=40)和对照组(n=40),均采用静吸复合全身麻醉。静脉注射咪唑安定、丙泊酚、芬太尼和罗库溴铵麻醉诱导后,气管插管行机械通气。麻醉维持采用瑞芬太尼0.1~0.2ug/kg/min泵注,吸入七氟醚2%~3%,间断给予罗库溴铵维持麻醉。分别于缝皮时静脉给予0.5mg/kg氯胺酮(氯胺酮组)和相同剂量的生理盐水(对照组)。记录两组患者拔管时间、苏醒时间及再次要求镇痛的患者例数、曲马多用量和不良事件的发生情况。分别于苏醒后15min(T1)、30min(T2)、60min(T3)、120min(T4)进行VAS、Ramsay评分。结果两组患者拔管时间、苏醒时间比较差异无统计学意义(P>0.05)。氯胺酮组要求镇痛人数(17/40)和曲马多用量(40.5mg)均低于对照组(25/40,70.6mg)(P<0.05)。患者苏醒后15min Ramsay评分氯胺酮组显著大于对照组(P<0.01),30min VAS评分对照组显著高于氯胺酮组(P<0.05)。两组患者不良反应无显著差异。结论颌面部手术瑞芬太尼麻醉后使用小剂量氯胺酮,可以有效缓解瑞芬太尼所致的痛觉过敏,无不良反应,临床应用安全可靠。

Objective To evaluate the inhibiting effects of small-dose ketamine on postoperative hyperalgesia after remifentanil-based anaesthesia oromaxillo-faeial surgery. Methods A total of 80 patients undergoing oral and maxillofacial surgery were randomly assigned to two groups, ketamine group （ n = 40 ） and control group （ n = 40 ）. Anesthesia was induced with midazolam, fentanyl, propofol and roeuronium and maintained with infusion of remifentanil （0. 1-0. 2p^g/kg/ rain） and sevoflurane. The patients were mechanically ventilated after teaeheal intubation. Ketamine was given before skin closing for inhibiting remifentanil-indueed postoperative hyperalgesia in the ketamine group and saline given in the control group. The emergence time, trachea extubation time, VAS and Ramsay scores were recorded and the tramadol consumption were compared. Results There was no significant difference in trachea extubation time and emergence time between the two groups. The number of patients and tramadol consumption in ketamine group were significantly lower than those in control group. Pain VAS scores in control group were significantly higher than those in ketamine group 30 minutes after emergence （P 〈0. 05）. The Ramsay scores in control group 15 minutes after emergence were lower than those in ketamine group （P 〈 0. O1 ）. The adverse drug reaction showed no significant difference between the two groups. Conclusion Small dose ketamine can prevent postoperative hyperalgesia after remifentanil-based anaesthesia without increasing the incidence of side effects.