氯胺酮、芬太尼和曲马多防治瑞芬太尼麻醉术后急性疼痛的效果观察  

Suppressive effects of ketamine, fentanil and tramadol on postoperative hyperalgesia after remifentanil-based anaesthesia.

作　　者：任长和[1] 张杨[1] 周述芝[1] 欧册华[1] 

机构地区：[1]泸州医学院附属医院麻醉科,四川泸州646000

出　　处：《海南医学》2012年第24期12-14,共3页Hainan Medical Journal

摘　　要：目的比较氯胺酮、芬太尼、曲马多对瑞芬太尼麻醉术后疼痛的作用。方法选择100例择期行腹腔镜胆囊切除术的患者,ASAⅠ～Ⅱ级,随机分为四组:氯胺酮组(K组)、曲马多组(T组)、芬太尼组(F组)、空白对照组(P组),每组各25例。术毕前10min,K组静脉注射氯胺酮0.4mg/kg,T组注射曲马多1.5mg/kg,F组注射芬太尼50μg,P组注射等容量的生理盐水。观察患者的苏醒时间,拔管后0h、0.5h、1h、2h、4h、8h、12h、24h各点的VAS评分、瑞芬太尼的用量以及恶心、呕吐、尿潴留、皮肤瘙痒等并发症。结果 (1)VAS:K组、T组、F组在术后0～24h各个监测点显著低于P组(P<0.05),T组、K组与F组比较差异无统计学意义(P>0.05);(2)F组、K组苏醒时间显著长于P组与T组(P<0.05),而P组与T组间差异无统计学意义(P>0.05);(3)T组不良反应发生率明显高于P组、F组与K组(P<0.05),而P组、F组与K组间差异无统计学意义(P>0.05)。结论瑞芬太尼麻醉后,预防性的使用氯胺酮、芬太尼、曲马多都可以减轻瑞芬太尼引起的疼痛过敏以及术后伤口的疼痛;芬太尼,氯胺酮可使苏醒时间延长;曲马多,芬太尼的不良反应发生率相对较高。Objective To comparison of the suppressive effects of ketamine, fentanil and tramadol on post- operative hyperalgesia after remifentanil-based anaesthesia. Methods One hundred ASA I - lI patients undergoing laparoscopie cholecystectomy （LC） were randomly divided into four groups： ketamine group （group K）, tramadol group （group D）, fentanil group （group F） and control group （group P）, each with 25 cases. 10 rain before the end of surgery, group K was given ketamine 0.4 mg/kg, group T was given tramndol 1.5 mg/kg, group F was given fentanil 0.05 }~g/kg, and group P was not given any medicine. The resuscitation time was measured. The eight-level VAS scores 0 h, 0.5 h, I h, 2 h, 4 h, 8 h, 12 h, 24 h after tracheal extubation were recorded. The general dosage of remifen- tanyl and adverse drug reactions, such as nausea, vomit, uroschesis and itch of skin, were recorded. Results （1） The VAS scores of group K, group T, group F were significantly lower than those of group P at individual monitoring-sta- tion after surgery （P〈0.05）, with no statistically significant differences among group T, group K and group F. （2） The revive time of group F and group K was significantly longer than that of group P and group T （P〈0.05）, while there has no statistically significant differences between group P and group T. （3） The adverse reaction rate of group T was significant differently higher than that of group P, group F and group K （P〈0.05）;while there has no significant differ- ences among group P, group F and group K. Conclusion After remifentanil-based anaesthesia, ketamine, fentanil and tramndol have significant suppressive effect on postoperative hyperalgesia. Ketamine and fentanil can prolong the resuscitation time, tramadol and fentanil result in relatively higher incidence of adverse drug reactions.

关 键 词：疼痛过敏 腹腔镜胆囊切除术 曲马多 氯胺酮 芬太尼 瑞芬太尼 

分 类 号：R614[医药卫生—麻醉学]