不同剂量氯胺酮超前镇痛对小儿腺样体消融术后疼痛的影响

Preemptive Analgesic Effect of Two Doses of Ketamine for Postoperative Pain Relief in Children Following Adenotonsillectomy

目的探讨不同剂量氯胺酮超前镇痛对小儿腺样体消融术后疼痛的影响。方法选取腺样体消融伴或不伴扁桃体摘除术患儿90例,ASA分级Ⅰ级,年龄2~9岁,体重13~36kg,采用随机数字表法将其分为3组,分别在麻醉诱导后静脉给予生理盐水(对照组),氯胺酮0.2mg/kg(K1组)和0.5mg/kg(K2组)。记录患儿苏醒期(0、15、30min、2、6、12h)FLACC评分,若FLACC>4分,给予曲马多和双氯芬酸钾肛栓补救镇痛。记录3组患儿手术持续时间、麻醉持续时间、拔管时间、苏醒时间、术后恶心呕吐、头痛及腹痛的发生情况。结果与对照组比较,K1和K2组在苏醒早期(0~30min)FLACC评分显著降低,补救药使用率显著减少(P<0.05)。与K1组比较,K2组苏醒期FLACC评分差异无统计学意义(P>0.05),但苏醒时间延长(P<0.05)。3组在2 h后FLACC评分、手术及麻醉持续时间、拔管时间,术后恶心、呕吐、腹痛及头痛发生率上差异无统计学意义(P>0.05)。结论术前静脉给予0.2mg/kg和0.5mg/kg氯胺酮均能显著减少小儿腺样体消融术后早期疼痛,但0.5mg/kg组可能导致苏醒时间延长,0.2mg/kg可能是一个更合适的剂量。

Objective To investigate the efficacy of two low doses of ketamine for postoperative pain relief in children following adenotonsillectomy.Methods Ninety ASA physical status Ⅰ patients, aged 2-9 years, scheduled for adenotonsillectomy were enrolled in this randomized, double-blinded study. Patients were divided into three groups of 30 each and received an intravenous injection of 0.9% saline （group C）, ketamine 0.2mg/kg （group K1）, or ketamine 0.5mg/kg （group K2）. FLACC scores were used to evaluate pain levels during 12h after surgery. Tramadol and diclofenac potassium suppositories were provided for pain relief if FLACC〉4. The operating time（OT）, anesthesia duration（AT）, extubation time（ET）and awaking time（AWT） were recorded. Adverse reactions such as nausea, vomiting, headache,abdominal pain and the requirement of rescue analgesic was recorded.Results Group C had significant higher FLACC scores than group K1 and K2 during the first 30min after operation. The requirement of analgesics was also higher in the control group（P〈0.05）. No significant difference of FLACC scores was found between group K1 and K2. However, children in K2 group have longer awaking time （P〈0.05）. There was no significant difference among three groups in the FLACC score after 2 hours.Conclusion A 0.2 or 0.5mg/kg dose of ketamine given before surgery by intravenous injection provides efficient pain relief in the early period after surgery. 0.2mg/kg may be preferable for its low incidence of deep sedation.