开胸术后静脉小剂量氯胺酮泵注可加强硬膜外镇痛的效果  

Low-dose intravenous ketamine potentiates epidural analgesia after thoracotomy

作　　者：丁燕群[1] 

机构地区：[1]常州市第二人民医院麻醉科,江苏常州213000

出　　处：《湖南中医药大学学报》2009年第9期71-73,76,共4页Journal of Hunan University of Chinese Medicine

摘　　要：目的考察静脉小剂量氯胺酮能否加强开胸手术后病人硬膜外镇痛的效果。方法45例病人随机分成两组:氯胺酮组(n=23),硬膜外镇痛泵使用至术后2d,同时以0.05mg/(kg·h)的量静脉持续给药至术后3d;安慰剂对照组(n=22),仅硬膜外镇痛泵使用至术后2d。之后分别在术后6h、12h、24h、48h、7d、1个月、3个月行疼痛评分,同时在7d、1个月、3个月等时间点询问病人切口的异常感觉。结果无论是在休息还是咳嗽状态下,术后24h、48h氯胺酮组的VAS评分明显少于对照组(P≤0.01),同样在术后第7d、1个月、3个月,与对照组相比,氯胺酮组病人中NRS评分大于1的人数明显减少(P<0.05)。结论静脉小剂量氯胺酮能加强开胸手术后病人吗啡布比卡因硬膜外镇痛的效果。Objective To investigate whether intravenous ketamine can potentiates epidural morphine analgesia. Methods Forty-five patients scheduled to undergo open thoracotomy were randomly assigned to receive one of two anesthesia regimens：conntinuous epidural infusion of bupivacane and morphine,along with intravenous infusion of ketamine （0.05mg/Kg/h,ketamine group,n=23） or placebo（control group, n=22） was continued for 2 days after surgery, and infusion of ketamine or placebo was continued for 3 days. Pain was assessed at 6h,12h,24h,48h,7d, lmonth,3month after surgery. Patients were asked about their pain ,abnormal sensation on the wound at 7 days and 1,3 months after surgery. Result The visual analog scale scores for pain at rest and on coughing 24 and 48 after thracotomy were lower in the ketamine group than in the control group（P〈0.01）. The numerical rating scale scores for baseline pain 1 and 3 months after thoracotomy were significantly lower in the ketamine group（P〈0.01） . Conclusions Very-low- dose ketamine potentiated morphine- bupivacane analgesia and reduced post-thoracotomy pain.

关 键 词：氯胺酮 硬膜外镇痛 吗啡耐受 痛觉增敏 开胸术后 

分 类 号：R655[医药卫生—外科学]