小剂量氯胺酮抑制内脏牵拉反应的临床观察  

Ketamine, an N-methyl-D-aspartate Receptor Antagonist, Inhibits Visceral Traction Response in Abdominal Surgeries under Epidural Anesthesia

作　　者：裘卫东 梁雅芬[2] 

机构地区：[1]浙江省临海市第一人民医院麻醉科,临海317000 [2]复旦大学附属中山医院麻醉科,上海200032

出　　处：《中国临床医学》2004年第4期649-650,共2页Chinese Journal of Clinical Medicine

摘　　要：目的 :观察硬膜外阻滞下辅助小剂量氯胺酮和咪唑安定用于抑制内脏牵拉反应的有效性和安全性 ,评价其对增加患者舒适性和术者满意度的作用。方法 :10 0例急诊硬膜外阻滞下行阑尾切除术的患者 ,随机分为 2组 ,每组各 5 0例。观察组在术前 5min依次给予咪唑安定 0 .0 4mg·kg-1,iv ,氯胺酮 0 .5mg·kg-1,iv .,对照组给予相同容量的生理盐水。观察并比较两者抑制内脏牵拉反应的效果。术毕由患者和手术医师对麻醉的满意度进行VAS评分。麻醉期间监测生命体征 ,随访不良反应。结果 :观察组抑制内脏牵拉反应的效果优于对照组 (90 %vs 4 5 % ,P <0 .0 1) ,观察组患者及手术医师对麻醉的满意度VAS评分均高于对照组 (P <0 .0 5 ) ,麻醉期间无严重并发症发生。结论 :小剂量氯胺酮和咪唑安定可作为一种安全有效的静脉辅助药 。Objective: To investigate the efficacy and safety of low-dose ketamine in inhibiting visceral traction responses in patients undergoing abdominal srgery under epidural anesthesia, and also the improvement of patients' comfort as well as surgeons' satisfaction under this technique. Methods: 100 patients undergoing emergency appendectomy under epidural anesthesia were randomly divided into two groups: the treatment group(Group A, n=50) and the control group(Group B, n=50).The treatment group was given midazolam 0.04 mg·kg -1,iv. 5 min before the surgery, followed by ketamine 0.5mg·kg -1,iv,while the same volume of saline was given to the control group. Efficacy in preventing visceral traction response between the two groups were compared, side effects were recorded. The satisfaction of the patients and surgeons were evaluated by VAS at the end of surgery. Results: The treatment group had a much higher effective rate in inhibiting visceral traction response compared with the control group (90% vs 45%,P<0.01). No serious side effects were observed. Both patients and surgeons in the treatment group had a higher satisfactory rate than those in the control group(P<0.05). Conclusion:Low-dose ketamine and midazolam is an effective and safe adjunct in preventing visceral traction response in abdominal surgery under epidural anesthesia. It significantly improves patients' comfort as well as surgeons' convenience.

关 键 词：小剂量 氯胺酮 内脏牵拉反应 安全性 有效性 硬膜外阻滞 

分 类 号：R614.42[医药卫生—麻醉学]