小剂量氯胺酮与吗啡合用于硬膜外镇痛的观察

A Clinical Study of Small Dose Ketamine Combined With Morphine in Inducing Analgesia

目的 观察小剂量氯胺酮与吗啡合用于硬膜外镇痛的效果。方法 72例硬膜外麻醉病人随机分成 4组 ,每组 18例 ,Ⅰ组为对照组 ,术后硬膜外腔注射生理盐水 8ml;Ⅱ ,Ⅲ ,Ⅳ组为实验组 ,硬膜外腔注入氯胺酮 10mg(8ml)、吗啡 2mg(8ml)与氯胺酮 10mg +吗啡 1mg(8ml)。用口述评分法评价术后镇痛的效果。结果 各组的镇痛时间 (h)分别为 4 .6± 1.6 ,4 .2± 1.8,30 .4± 9.8和 2 8.2± 8.6 ,Ⅲ、Ⅳ组的镇痛时间明显较Ⅰ和Ⅱ组长 ,P <0 .0 5 ,Ⅲ和Ⅳ组间无统计学差异。各组中Ⅲ组的副作用最大。结论 小剂量氯胺酮与吗啡合用既增强吗啡镇痛效果又能明显减少吗啡的副作用。

Objective This study was designed to investigate the effect of small dose ketamine combined with morphine induced analgesia.Methods 72 Patients performed epidural analgesia were allocated to four groups at random Group Ⅰ was control one,and the others (Ⅱ～Ⅳ) were test ones.The Patients in control group received 8 ml of normal saline alone;the patiants in test groups received 10 mg ketamine,2mg morphine,10mg ketamine+1mg morphine in 8ml normal saline respectively.VAS score was used to define the analgesic effect. Results The analgesia durations in group Ⅳ were 4.6±1.8,4.2±1.6,30.4±9.8 and 28.2±8.6hours respectively.Durations of group Ⅰ～Ⅱwere significantly shorter than that of gruop Ⅲ～Ⅳ ( P <0.05).The incidence of side effect in group Ⅲ was the highest among groups. Conclusion Small dose ketamine of epidural injection can improve the effect of morphineinduced analgesia and reduce the side effect of morphine.