比较曲马多与小剂量氯胺酮对瑞芬太尼麻醉术后的镇痛作用  

Comparison of the Suppressive Effects of Tramadol and Low-dose Ketamine on the Patients with Postoperative Hyperalgesia after Remifentanil-based Anaesthesia

作　　者：郁葱[1] 罗玉林[1] 肖水生[2] 李勇[2] 张青[3] 

机构地区：[1]重庆医科大学附属口腔医院麻醉科 [2]重庆医科大学附属口腔医院颌面外科,重庆400015 [3]重庆医科大学附属口腔医院

出　　处：《华西口腔医学杂志》2005年第5期404-406,共3页West China Journal of Stomatology

摘　　要：目的比较曲马多和小剂量氯胺酮对瑞芬太尼麻醉术后的镇痛作用,为临床合理应用瑞芬太尼提供依据.方法选择美国麻醉医师协会分级为Ⅰ～Ⅱ级的口腔颌面外科手术患者60例,随机分为对照组(C组)、曲马多组(T组)和小剂量氯胺酮组(K组),每组20例.3组均采用静吸复合麻醉,术毕T组给予曲马多0.3 mg/kg、K组给予氯胺酮0.5 mg/kg镇痛,C组暂不给药,当患者出现中等程度疼痛时给予曲马多0.3 mg/kg.记录3组患者拔除气管导管后的口述疼痛评分,拔管后1、2、3、4、12、24 h的视觉疼痛模拟评分(VAS),再次要求镇痛的时间和拔管后24 h内的不良反应.结果 3组间拔管后的口述疼痛评分无统计学差异,术后1、2、3、4 h 的VAS则有统计学差异,K组在4个时间点均低于C组,2、3、4 h时低于T组(P<0.05),而3、4 h时T组与C组间无统计学差异.C、T组患者再次要求镇痛时间均较K组提前;3组间麻醉后不良反应无统计学差异(P＞0.05).结论小剂量氯胺酮对采用瑞芬太尼麻醉手术的术后疼痛有明显的抑制作用.Objective To compare the suppressive effects of tmmadol and low-dose ketamine on postoperative hyperalgesia after remifentanil-based anaesthesia. Methods A total number of sixty ASA Ⅰ- H adult patients who undergone the operation of cranio-cervical region were assigned to three groups randomly, controlled group（ Group C）, tramadol group（ Group T） and low-dose ketamine group（Group K）. Before the end of surgery, Group T was given tramadol 0.3 mg/kg, Group K was given ketanaine 0.5 mg/kg and Group C wasn＇t given any medicine. When the visual analogue scale （VAS） score of the group C was over five, tramadol 0.3 mg/kg was given to the patients. The four-level verbal rating scale after trachea extubation, VAS score, the time of requiring analgesia again by patients and adverse drug reactions such as nausea, vomit, diplopia and hallucination were recorded for 24 hours after surgery. Results After operation, the VAS score of Group C was much higher than that of Group K in the first 4 hours and Group T was higher than Group K during 2, 3 and 4 hours （ P 〈 0.05 ）. The time of requiring analgesia by patients in Group C and Group T was earlier than Group K. The adverse drug reaction showed no significant difference in three groups. Conclusion Low-dose ketamine had significant suppressive effect on patients with postoperative hyperalgesia and acute opioid tolerance after remifentanil-based anaesthesia.

关 键 词：小剂量氯胺酮 曲马多 瑞芬太尼 疼痛 

分 类 号：R782[医药卫生—口腔医学]