小剂量氯胺酮用于术后静脉自控镇痛的临床效果评价  

A Clinical Appraisal of the Effect of Subanesthetic Doses of Ketamine in Postoperative Patient-controlled Intravenous Analgesia

作　　者：廖志品[1] 张毅[1] 张咸伟[1] 田玉科[1] 

机构地区：[1]华中科技大学同济医学院附属同济医院麻醉科,武汉430030

出　　处：《医药导报》2006年第2期130-132,共3页Herald of Medicine

摘　　要：目的观察小剂量氯胺酮用于术后静脉自控镇痛的临床疗效。方法80例ASAⅠ-Ⅱ级需行中下腹手术的患者，在气管插管、静脉吸入复合麻醉下完成手术，均在手术结束前开始缝合皮肤时使用微量镇痛泵。该80例患者随机分为4组，即氯胺酮Ⅰ组（K1组）、氟胺酮Ⅱ组（K2组）、芬太尼组（F组）、吗啡组（M组），每组20例。4组自控静脉镇痛药物的负荷剂量分别为0．25，0．50mg·kg^-1，1μg·kg^-1和0．15mg·kg^-1，背景输注量分别为10，20mg·h^-1，10μg·kg^-1和1mg·h^-1，按压剂量分别为10，20mg，10μg和0.5mg，间隔时间均为5min。观测患者24h内心率、血压、呼吸频率、脉搏血氧饱和度、视觉模拟评分（VAS）、Prince Henry评分（PHS）、镇静评分（SS）以及不良反应发生率，并记录患者24h内用药量。结果K1组VAS、PHS显著高于其他3组（均P〈0．05），4组患者SS差异无显著性；M组恶心呕吐发生率高于K1、K2和F组（均P〈0．05）；F和M组肛门排气时间延长发生率高于K1组和K2组（均P〈0．05）。结论适当小剂量的氯胺酮能够获得与吗啡、芬太尼相同的镇痛效果，且镇痛效果满意，还可以降低术后肛门排气时间延长和恶心的发生率。Objective To survey the clinical therapeutic effectiveness of subanesthetic doses of ketamine in postoperative patient-controlled intravenous analgesia （PCIA） . Methods 80 patients of ASA grade Ⅰ-Ⅱ were subjected to mid-lower abdominal operations under combined endo tracheal intuhation and intravenous anesthesia. Microanalgesic pump was started to work at the time when the skin was sutured before termination of the surgery. The patients were then randomly divided into 4 equal groups ： K1 （ ketamine group 1 ）, K2 （ ketamine group 2） , F （ fentanyl group） and M （ morphine group）. The loading doses of the patient-controlled analgesics of the 4 groups were 0.25 mg·kg^-1 ,0.50 mg·kg^-1 , 1 g , kg1 and 0.15 mg·kg^-1,respectively . The background infusion doses were 10 mg·h^-1, 20 mg·h^-1,10 g·h^-1 and 1 mg·h^-1, respectively ,while the pressing doses were 10 rag, 20 mg, 10 g and 0.5 mg , respectively ,with intervals of 5 rain. Heart rate, blood pressure , respiratory rate , pulse blood oxygen saturation , visual analogue score （VAS）, Prince Henry Score （PHS）, sedation score （SS） and incidence of adverse reactions within the following 24 h were kept under observation and total doses of the drugs used in the 24 h were noted down. Results The VAS and PHS in patients of group K1 were strikingly higher than those of the other 3 groups （P 〈 0. 05 ）. The differences between the SS in patients of the 4 groups were not significant （ P 〉 0. 05 ）. The postoperative incidence of nausea and vomiting in patients of group M was higher than those in patients of the other 3 groups （P 〈0.05）. The incidences of delayed postoperative flatus passing in patients of group F and group M were higher than those in patient of group K1 and group K2 （P 〈 0.05）. Conclusion When used in postoperative PCIA, proper suhanesthetic doses of ketamine was shown to exert the same and satisfying effects as those of morphine or fentanyl and the incidences of nausea, vomiting and delayed fla

关 键 词：氯胺酮 芬太尼 吗啡 患者自控镇痛 

分 类 号：R971.2[医药卫生—药品] R969.4[医药卫生—药学]