氯胺酮与小剂量芬太尼联合用于PCIA的临床观察  

Clinical evaluation of ketamine combined with small dose fentanyl for post-operative analgesia

作　　者：刘洪涛[1] 吴新军[1] 王俊科[1] 

机构地区：[1]中国医科大学附属第一临床学院麻醉科,沈阳市110001

出　　处：《临床麻醉学杂志》2002年第5期252-253,共2页Journal of Clinical Anesthesiology

摘　　要：目的　观察微量氯胺酮与小剂量芬太尼联合用于术后病人自控静脉镇痛 (PCIA)的效果及不良反应 ,并与较大剂量芬太尼PCIA进行比较。方法　选择ASAⅠ～Ⅱ级、年龄 (4 5 8± 11 2 )岁、全麻下行腹部手术病人 80例 ,随机分为四组 :Ⅰ组为芬太尼 2 0mg ,Ⅱ组为 1 5mg芬太尼 +2 5 0mg氯胺酮 ,Ⅲ组为 1 5mg芬太尼 +5 0 0mg氯胺酮 ,Ⅳ组为 1 5mg芬太尼 +75 0mg氯胺酮 ;各组均加 5mg氟哌啶 ,然后加生理盐水至 10 0ml。PCIA持续输注速度为 2 4μl·kg- 1 ·h- 1 。记录术后 4、2 4、48及 72小时的VAS评分、镇静评分、呼吸次数及SpO2 变化情况。结果　Ⅱ组VAS评分四个时点均明显高于Ⅰ组 (P <0 0 5或P <0 0 1)。Ⅰ组出现睡眠的病人也较多。结论　适量氯胺酮与较小剂量芬太尼联合用于术后PCIA ,能明显改善病人嗜睡的状况 ,镇痛效果也较理想 。Objective To observe the effect of PCIA with ketamine and small dose fentanyl on the side effects accompanied by PCIA with larger dosage of fentanyl.Methods 80 adult patients,ASA Ⅰ-Ⅱ,were randomly divided into four groups.2mg fentanyl/100ml,(1.5mg fentanly+250mg ketamine)/100ml,(1.5mg fentanyl+500mg ketamine)/100ml,or (1.5mg fentanyl+750mg ketamine)/100ml was used in group Ⅰ,Ⅱ,Ⅲ or Ⅳ respectively.5mg doperidol/100ml was added in each of four groups.VAS,sedative score,RR,SpO 2 were recorded at the time points of 4,24,48 and 72h after operation.Results VAS in group Ⅱ was significantly higher than that in group Ⅰ at all four time points(P<0.05 or P<0.01).So was the number of patients more sedated.Conclusion PCIA with proper dose of ketamine together with small dose of fentanyl could provide better postoperative analgesia without increase of sedation and respiratory depression.

关 键 词：氯胺酮 芬太尼 术后镇痛 自控静脉镇痛 疗效 不良反应 

分 类 号：R614[医药卫生—麻醉学]