氯胺酮对瑞芬太尼诱发痛觉敏化防治作用临床观察  

Clinical Observation of Ketamine for Preventing Remifentanil Induced by Postoperative Hyperalgesia with Patients Undergoing Abdominal Surgery

作　　者：高淅[1] 赵敏[1] 马磊[1] 朱箫玲[1] 王强[1] 曾毅[1] 冀玲[1] 朱正华[1] 陈晓梅[1] 陈绍洋[1] 

机构地区：[1]第四军医大学西京医院麻醉科,陕西西安710032

出　　处：《现代生物医学进展》2013年第17期3280-3284,共5页Progress in Modern Biomedicine

基　　金：国家重点基础发展规划项目(973项目)(4341154052)

摘　　要：目的:研究持续输注瑞芬太尼与术后痛觉敏化的关系,分析芬太尼或氯胺酮防治痛觉敏化的效果。方法:48例开腹患者随机分四组,生理盐水组(RC组)、芬太尼组(RF组)和氯胺酮组(RK组),术中均输注瑞芬太尼0.15～0.20μg/(kg.min)其中RF组术毕静注芬太尼1μg/kg,RK组术中联合输注氯胺酮10μg/(kg.min),以及术中静注芬太尼组(FC组)分次静注芬太尼5～6μg/kg,四组均复合七氟烷吸入维持BIS45～55,记录病人自控静脉镇痛泵(PCIA)情况,评估术后Ramsay评分和VAS评分。结果:RC组术后早期24 h VAS评分明显高于FC组(P<0.05);RF组虽可使术后最初60 min VAS评分较RC组明显降低(P<0.05),但6 h和12h VRS评分与RC组无明显差异;RK组术后VRS评分较RC组明显降低(P<0.05),与FC组相仿;RC组与其它三组相比,首次应用PCA时间提前、按压次数增多、芬太尼用量增大。结论:持续输注瑞芬太尼可诱发术后痛觉敏化,联合输注小剂量氯胺酮可较好防治瑞芬太尼所致的痛觉敏化。Objective： To investigate the relation of continuous infusion of remifentanil and postoperative pain sensitization and analyze the preventive effect of fentanyl and ketamine in pain sensitization.Methods： 48 patients（n=12 each）who received laparotomy operation were randomly divided into four groups： remifentanil＋ saline group（RC）,remifentanil＋ fentanyl group（RF）,remifentanil＋ Ketamine group（RK）,fentanyl group（FC）.The first three groups received remifentanil infusion at the rate of 0.15～0.20 μg/kg/（kg·min） during operation,patients in RF group recepted fentanyl 1ug/kg at the end of surgery,we gave ketamine to RK group persons by 10 μg/kg（kg·min）.FC group just received fentanyl 5-6 μg/kg/kg to maintain analgesic.Anesthesia was equally maintained with sevoflurane and to keep bispectral index（BIS） at 45～55.Cumulative PCA requirements and side effect were recorded for 24 h after operation.Ramsay sedation scale（RSS） were assessed at 5,10,20 and 30min after operation.Visual analogue scale（VAS） were measured at 10 min,20 min,30 min,60 min,6 h,12 h,24 h and 36 h.Results： RC group had significantly higher VAS scores compared with that in FC group at 24 hours postoperatively（p0.05）,and the VAS score of RF group was lower than that in the RC group at the time of 60 min after operation,but there was no significant difference at 6h and 12 h.The VRS score was obviously lower than RC group RK（P0.05）,but no significant difference from FC group;The first time to use PCA and PCA times in other three groups showed much better than RC group.It was also observed that the need of fentanyl was more in RC group than others.Conclusion： The continuous infusion of remifentanil can induce postoperative pain sensitization,combined with small dose of ketamine infusion may be a better way to prevent such event.

关 键 词：瑞芬太尼 痛觉敏化 防治 氯胺酮 

分 类 号：R614[医药卫生—麻醉学]