小剂量氯胺酮预防瑞芬太尼引起的术后痛觉过敏效果观察

Observation of small dose ketamine in prevention of postoperative hyperalgesia induced by remifentanil

目的观察小剂量氯胺酮在腹腔镜全子宫切除术患者全身麻醉下对瑞芬太尼术后痛觉过敏的影响。方法将120例腹腔镜全子宫切除术患者随机分为4组,R组切皮前1min静脉注射生理盐水5ml,RK1组、RK2组、RK3组切皮前1min分别静脉注射小剂量氯胺酮0.25mg/kg、0.5mg/kg、0.75mg/kg后静脉泵注氯胺酮2μg·kg-1·min-1至手术结束。记录拔管时间、拔管后5min的Ramsay镇静评分、首次疼痛时间及当时VAS评分、术后需要给予镇痛治疗的患者例数,分别记录手术结束后无镇痛要求患者各时间点静息、运动状态下VAS疼痛评分及4组患者术后不良反应发生情况。结果术后首次疼痛时间R组早于其他三组(P<0.05),RK1组早于RK2组和RK3组(P<0.05);术后首次VAS评分R组高于其他三组(P<0.05);R组需要术后镇痛患者例数显著多于其他三组;术后各时间点患者静息和运动状态时的VAS评分,6h内R组高于其他三组(P<0.05),RK1组高于RK2组和RK3组(P<0.05)。结论小剂量氯胺酮可预防瑞芬太尼引起的痛觉过敏,延迟术后疼痛出现时间并减轻患者术后疼痛程度。切皮前1min静注氯胺酮0.5mg/kg,继以2μg·kg-1·min-1泵注可较好地减轻患者术后疼痛,且不增加术后不良反应的发生。

Objective To observe the effect of small dose ketamine in prevention of hyperalgesia in patients undergoing laparoscopic total hysterectomy under general anesthesia with remifentanil. Methods A total of 120 patients undergoing laparoscopic total hysterectomy were randomly divided into 4 groups. Group R were injected 5 ml saline intravenously 1 minute before skin incision. Group RK1, group RK2 and group RK3 were respectively intravenously injected 0.25 mg/kg, 0.5 mg/kg,0.75 mg/kg of small dose ketamine 1 minute before skin incision and continuous intravenous infusion of ketamine at 2μg·kg-1·min-1 till the end of the operation. Recorded the time of extubation, the Ramsay Sedation score at 5 min after extubation, the postoperative pain for the first time and the VAS pain score, the number of patients requiring pain relief after surgery. The VAS pain score at resting and dynamics state were recorded at each time point after operation in the patients without pain requiring. The occurrence of adverse reactions of four groups were recorded. Results The first postoperative pain time of group R appeared earlier than the other three groups（P〈0.05）,which of group RK1 appeared earlier than group RK2 and group RK3（P〈0.05）. The first postoperative VAS pain score of group R was higher than the other three groups（P〈0.05）, and the number of patients requiring postoperative analgesia in group R was significantly more than the other three groups. Within 6 h after operation, the VAS pain score of resting and dynamics state at each time point of group R was higher than the other three groups（P〈0.05）. The pain score of group RK1 was higher than group RK2 andgroup RK3（P〈0.05）. Conclusion A small dose of ketamine can prevent remifentanil induced hyperalgesia, and delay the time of postoperative pain appearance while reducing the degree of postoperative pain. Using ketamine 0.5 mg/kg before skin incision and intraoperative injection of ketamine of 2μg·kg^-1·min^-1 during the operation can better reduce the postoperative pain,and does not increase postoperative adverse events.