小剂量氯胺酮复合芬太尼术后静脉镇痛

Application of a small dose ketamine combined with fentanly for intravenous postoperative analgesia

目的 比较小剂量氯胺酮联合芬太尼与单纯芬太尼术后静脉镇痛的临床效应。方法选择行上腹部手术后患者 12 0例 ,随机均分为三组 ,每组 4 0例 ,以一次性静脉镇痛泵 (2ml/h)分别行静脉术后镇痛。F组 :单纯芬太尼镇痛 ,0 4 μg·kg-1·h-1芬太尼 +5mg氟哌利多。KF1组 :氯胺酮联合芬太尼镇痛 ,0 2 μg·kg-1·h-1芬太尼 +40 μg·kg-1·h-1氯胺酮 +5mg氟哌利多。KF2组 :氯胺酮联合芬太尼镇痛 ,0 2 μg·kg-1·h-1芬太尼 +80 μg·kg-1·h-1氯胺酮 +5mg氟哌利多。各组镇痛泵中药物均用医用盐水稀释至 10 0ml。观察各组患者镇痛 4 8小时内的静息镇痛评分 (VAS方法 )、恶心呕吐、皮肤瘙痒、尿潴留和幻觉的发生情况。结果 三组患者的静息镇痛评分在 12小时内KF1组和KF2组明显低于F组 (P <0 0 5 ) ,而在 12小时后没有明显差别 (P >0 0 5 ) ;恶心呕吐、皮肤瘙痒和尿潴留发生率KF1组和KF2组显著低于F组 (P <0 0 1)。KF1组和KF2组之间在静息镇痛评分和并发症发生方面没有明显差别。三组中均无幻觉发生。结论 小剂量氯胺酮用于术后静脉镇痛可明显减少芬太尼的剂量 ,使恶心呕吐、皮肤瘙痒和尿潴留发生率降低 。

Objective To compare the static pain score and the complications of fentanyl intravenous postoperative analgesia with those of fentanyl combined with a small dose of ketamine.Methods One hundred and twenty patients after the upper abdomen operation undergoing intravenous postoperative analgesia were randomly divided into three groups( n= 40 in each group).Group F:fentanyl 0 4μg·kg -1 ·h -1 plus droperidol 5mg;group KF1:fentanyl 0 2μg·kg -1 ·h -1 plus ketamine 40μg·kg -1 ·h -1 plus droperidol 5mg;group KF2:fentanyl 0 2μg·kg -1 ·h -1 plus ketamine 80μg·kg -1 ·h -1 plus droperidol 5mg.The drugs in each group were diluted in normal saline 100ml with a disposable perfusion pump of 2ml/h.The static pain scores,incidences of nausea,vomiting,itching,urinary retention and illusion were recorded during 48h intravenous postoperative analgesia.Result The static pain score of group KF1 and group KF2 during first 12 hours was significantly lower than that of group F( P< 0 05),which became similar after 12 hours.The incidences of nausea,vomiting,itching and urinary retention in group KF1 and group KF2 were also significantly lower than those of group F( P< 0 01).There were no obvious differences in the static pain score and the adverse effects between group KF1 and group KF2.And there was no illusion occurred in three groups.Conclusion A small dose of ketamine used for intravenous postoperative analgesia could reduce fentanyl requirement,and also reduce the incidences of nausea,vomiting,itching and urinary retention.The analgesic effects of this method is better than that of fentanyl alone. [