小剂量氯胺酮对上腹部手术术后镇痛的效应

Effects of Low Dose Ketamine During Anesthesia on Postoperative Analgesia

目的 研究术中应用小剂量氯胺酮对上腹部手术有无超前镇痛的效应。方法 采用随机对照双盲的前瞻性临床试验法,40例择期行上腹部手术的患者全部采用硬膜外复合全麻法,随机分为两组。氯胺酮组(KAT组)20例,手术前15 min静脉给予氯胺酮0.3 mg·kg^(-1),继之持续静脉输注氯胺酮3 μg·kg^(-1)·min^(-1)至手术结束前15min;对照组(NS组)20例给予同等容量的生理盐水。患者术后均采用自控硬膜外镇痛(PCEA),在麻醉恢复室和术后3、6、12、24、48 h随访PCEA用量、视觉模拟镇痛评分(VAS)及患者有无精神异常。结果KAT组术后3和6hPCEA用量显著少于NS组,VAS评分显著低于NS组,其余各时点无显著差异,两组未有精神异常发生。结论 术中静脉给予小剂量氯胺酮能提高术后早期PCEA镇痛质量及减少阿片类用量。

Purpose: To determine if preoperative administration of intravenous low-dose ketamine and followed by a continues ketamine infusion can ameliorate postoperative pain and reduce postoperative analgesic consumption following upper abdominal srugery. Methods: A randomized, double blinded, prospective clinical trial study was used. Forty patients undergoing gastrectomy were randomly subdivided into two groups and geneal anesthesia combined with epidural anesthesia were performed. Patients in group I (KAT, n = 20) were given 0.3mg&middotkg-1 ketamine 15 min prior to skin incision followed by a ketamine infusion of 3μg&middotkg-1&middotmin-1, which was discontinuned 15 min prior to abdominal closure. Patients in group II (NS, n = 20) were same volume of normal soline instead of ketamine. Postoperatively, all patients received patient controlled epidural analgesia (PCEA). Postsurgical pain intensity was rated by a visual analog scale (VAS) at rest and cumulative fentanyl consumption. The incidence of mental disorder was also observed. Results: Compared with NS group, KET group demonstrated a significant reduction in VAS scores at rest at 3 and 6h, and analgesic consumption was significantly lower at the same time. No mental disorder happened in both groups. Conclusions: The results suggest that intravenous low-dose ketamine does not previde postsurgical pain relief and does not decrease postoperative analgesic requirements except for earlier pieriod after upper abdominal surgery.