氯胺酮复合舒芬太尼用于全膝关节置换术后镇痛的效果

Outcomes of postoperative analgesia with ketamine combined with sufentanyl in patients after total knee replacement

目的观察氯胺酮复合舒芬太尼用于全膝关节置换(TKR)术后镇痛的效果。方法75例TKR患者随机均分为三组,术后实施患者自控静脉镇痛(PCIA)。镇痛药为氯胺酮2.0mg/kg+舒芬太尼2.0μg/kg(A组)、舒芬太尼2.5μg/kg(B组)或舒芬太尼2.0μg/kg(C组),加生理盐水至100ml。PCIA参数:背景输注2ml/h;PCIA剂量0.5ml,锁定时间15min。记录术后48h内的VAS疼痛评分、Ramsay镇静评分、PCIA按压次数和不良反应发生情况。结果静息状态下,A、B、C组VAS疼痛评分依次升高(P<0.05),且A组活动状态下的VAS疼痛评分低于B组和C组(P<0.05)。B组术后6h和12h时的Ramsay镇静评分高于A组和C组(P<0.05)。A组和B组48h内的PCIA按压次数少于C组(P<0.05)。B组恶心、眩晕发生率高于A组和C组(P<0.05)。结论小剂量氯胺酮复合舒芬太尼用于TKR术后静脉PCIA镇痛效果优于舒芬太尼单用。

Objective To investigate the efficacy of postoperative analgesia with ketamine combined with sufentanyl in the patients after total knee replacement（TKR）. Methods Seventy-five patients underwent TKR were equally randomized into three groups and patient-controlled intravenous analgesia（PCIA） was performed in postoperative 48 hours. Analgesic solution consisted of ketamine 2. 0 mg/kg plus sufentanyl 2. 0 μg/kg （group A）, sufentanyl 2.5 μg/kg （group B） or sufentanyl 2.0μg/kg（group C）, which was added in normal saline upto 100 ml. The PCIA device was programmed for the variables of the background infusion of 2 ml/h, bolus dose of 0. 5 ml, and lockout interval of 15 minutes. VAS pain score, Ramsay sedation score, PCIA-pressing frequency were evaluated and adverse effects were recorded during PCIA. Results VAS pain score at rest was in an order of group C〉group B〉group A（P〈0. 05） ,which with activity was lower in group A than that in groups of B and C（P〈0. 05）. Ramsay sedation scores at 6 h and 12 h after operation were higher in group B than those in groups of A and C （P〈0. 05 ）. Compared with group C, PCIA-pressing frequency within 48 hours was lower in groups of A and B （P〈0. 05 ）. The incidence of nausea and dizziness in group B was higher than that in groups of A and C （P〈0. 05 ）. Conclusion Postoperative intravenous PCIA with low-dose ketamine combined with sufentanyl is better than that with sufentanyl alone in the patients after TKR.