小儿术前应用不同剂量氯胺酮的超前镇痛效果  

The effect of preemptive ketamine on caudal morphine for analgesia in children

作　　者：吕金[1] 陈平健[1] 于桂杰[2] 陈卫民[1] 

机构地区：[1]中国医科大学附属第二医院麻醉科,沈阳110004 [2]辽宁省人民医院麻醉科,沈阳110004

出　　处：《实用药物与临床》2005年第4期19-20,共2页Practical Pharmacy and Clinical Remedies

摘　　要：目的通过术前肌注不同剂量氯胺酮对小儿骶管吗啡镇痛作用的影响,探讨氯胺酮超前镇痛在小儿麻醉中的应用。方法60例ASAⅠ级进行下腹部手术的患儿分为3组,术前分别肌注氯胺酮1mg/kg、2mg/kg及0.9%NaCl1ml;手术结束时行骶管阻滞,注入0.8%利多卡因和0.02mg/kg吗啡的混合液,容积为0.6ml/kg。观察术后2、4、8、122、4h疼痛情况,并用视觉模拟评分法进行评估,记录各时点的血压、脉搏、脉搏血氧饱和度以及恶心呕吐、尿潴留等副作用。结果术前肌注氯胺酮1mg/kg能增强骶管阻滞的镇痛效果,而肌注氯胺酮2mg/kg临床作用与之相似,但副作用却显著增高。结论术前肌注氯胺酮1mg/kg能增强骶管吗啡的镇痛效果,并可减少吗啡的副作用。Objective To evaluate outcomes of preemptive a small dose ketamine and the effect to caudal morphine analgesia in Children. Methods Sixty ASA Ⅰ and Ⅱ patients, scheduled for elective lower abdominal surgery were enrolled and randomly divided into there groups, 20 patients in each group. Patients were received ketamine 1, 2mg/kg or saline 1ml before operation,respectively. At the end of operation, Caudal block was performed, injected 0.02mg/kg morphine ＋ 0.8 % lidocaine, the volume was 0.6 ml/kg. Data including blood pressure, heart rate, pulse oxygen saturation, VAS for pain at 2,4, 8, 12,24h after operation and side effects including nausea, vomiting, pruritus and urinary retention were recorded by the same follower. Results Pre-operational ketamine 1mg/kg im can increase the effects of caudal morphine postoperative analgesia. While ketamine 2mg/kg im has similar clinical effect but more sideeffects. Conclusion Pre-operational ketamine 1mg/kg im can increase the effects of caudal morphine postoperative analgesia and decrease the sideeffect of morphine.

关 键 词：氯胺酮 吗啡 止痛 小儿 骶管麻醉 

分 类 号：R726.1[医药卫生—儿科]