小剂量氯胺酮减轻瑞芬太尼致术后痛觉过敏的临床研究  

Clinical research of low-dose ketamine on alleviating postoperative hyperalgesia after remifentanil-based anesthesia

作　　者：杭黎华[1] 邵东华[1] 王洪[1] 孙文晋[1] 黄霞萍[1] 顾月萍[1] 

机构地区：[1]江苏大学附属人民医院麻醉科,江苏镇江212002

出　　处：《重庆医学》2011年第9期843-844,847,共3页Chongqing medicine

基　　金：江苏省镇江市社会发展资助项目(SH2008051)

摘　　要：目的观察小剂量氯胺酮(KT)能否减轻瑞芬太尼致术后痛觉过敏(OI H)及测定其半数有效量(ED50)。方法选择40例ASAⅠ～Ⅱ择期全身麻醉(全麻)腹腔镜下行胆囊切除术的成年患者,随机分组设计,分为瑞芬太尼组(R组)及KT 0.2、0.4、0.6 mg/kg 4组,每组10例。R组麻醉诱导后,持续泵注瑞芬太尼0.25μg/(kg.min);丙泊酚3～4 mg/(kg.h)维持麻醉。KT0.2、0.4、0.6 mg/kg组,麻醉诱导后静脉注射KT0.2、0.4、0.6 mg/kg,麻醉维持同R组。观察术后患者的苏醒、拔管时间及拔管后10 min的VAS评分及用概率回归法测定KT减轻瑞芬太尼致术后OI H的ED50。结果 R组和KT0.2、0.4、0.6 mg/kg组患者苏醒和拔管时间差异无统计学意义(P>0.05),拔管后10 min的VAS评分,KT 0.4、0.6 mg/kg组显著低于R组(P<0.01)。KT减轻瑞芬太尼致术后OI H的ED50为0.25 mg/kg(95%可信范围:0.11～0.33 mg/kg)。结论小剂量KT能减轻瑞芬太尼所致的术后OI H,其ED50是0.25 mg/kg。Objective To observe whether low-dose ketamine can alleviate postoperative hyperalgesia after remifentanil-based anesthesia and to determinate ED50.Methods Forty ASA ⅠorⅡpatients,undergoing laparoscopic cholecystectomy during general anesthesia,were randomized block design and allocated to four groups（n=10）：remifentanil（R） group,ketamine（KT）0.2,0.4,0.6 mg/kg group.After induction of anesthesia,anesthesia of R group was maintained with infusion of remifentanil 0.25 μg/（kg·min）and propofol 3-4 mg/（kg·min）.After induction of anesthesia,KT 0.2,0.4,0.6 mg/kg group administatered 0.2,0.4,0.6 mg/kg ketamine.Anesthesia maintenance was the same with R group.The time of awake,extubation and VAS scores（10 min after trachea extubation） were recorded.ED50 of ketamine on alleviating postoperative hyperalgesia was determined by using probit method.Results There were no significantly difference at the time of awake and extubation among four groups（P0.05）.Compared with R group,VAS scores of KT 0.4,0.6 mg/kg group were markedly smaller（P0.01）.Alleviating postoperative hyperalgesia,ED50 of ketamine was 0.25 mg/kg（95%CI,0.11-0.33 mg/kg）.Conclusion Low-dose ketamine can alleviate postoperative hyperalgesia after remifentanil-based anesthesia and ED50 of ketamine is 0.25 mg/kg.

关 键 词：氯胺酮 痛觉过敏 半数有效量 

分 类 号：R614[医药卫生—麻醉学]