小剂量氯胺酮在断指再植围术期的平衡镇痛作用  

THE EFFECT OF LOW-DOSE KETAMINE ON PERIOPERATIVE BALANCED ANALGESIA FOR SEVERED FINGER REUNION

作　　者：曲彦亮[1] 申恒花[2] 王德明[1] 张元信[1] 武春敏[1] 周翔[3] 

机构地区：[1]中国人民解放军第401医院全军手外科中心,山东青岛266071 [2]青岛市第八人民医院麻醉科 [3]广州军区武汉总医院麻醉科

出　　处：《齐鲁医学杂志》2015年第3期292-293,297,共3页Medical Journal of Qilu

基　　金：济南军区后勤科研项目(CJN090L68)

摘　　要：目的观察小剂量氯胺酮在断指再植围术期的平衡镇痛作用。方法选取ASAⅠ～Ⅱ级断指再植病人120例，随机分为氯胺酮组（K组）和生理盐水组（N组），每组60例。于神经丛刺激仪下行腋路臂丛神经阻滞麻醉，手术开始前5min，K组静注氯胺酮0．15mg／kg，N组静注生理盐水0．15mg／kg。术后两组病人均给予自控静脉镇痛（PCIA），将舒芬太尼150μg加托烷司琼5mg以生理盐水稀释至120mL，以2．0mL／h持续镇痛48h。比较两组臂丛麻醉效果，止血带耐受效果，术后镇痛效果，PCIA需求按压和有效按压次数，术后恶心呕吐、皮肤瘙痒发生率。结果K组臂丛麻醉效果及止血带耐受效果均优于N组（u=3．154、1．986，P〈0．05）。两组术后镇痛效果均满意，视觉模拟评分差异无统计学意义（P〉0．05）。K组术后48h内PCIA需求按压和有效按压次数均显著低于对照组（t=5．7、3．7，P〈0．05）。两组术后恶心呕吐、皮肤瘙痒发生率差异无统计学意义（P〉0．05）。结论小剂量氯胺酮在断指再植围术期中的平衡镇痛作用效果显著，提高了阻滞麻醉的满意率和止血带耐受率，减少了PCIA按压次数，且并未增加病人不良反应。Objective To observe the effect of low-dose ketamine on perioperative balanced analgesia in severed finger reunion （SFR）. Methods This study consisted of 120 ASA Ⅰ～Ⅱ patients undergoing SFR and evenly randomized to ketamine group and normal saline group. The patients received axillary brachial plexus block under the guidance of a nerve stimulator. At 5 minutes before the surgery, intravenous ketamine （0.15 mg/kg） was given to patients in the ketamine group, and normal saline （0.15 mg/kg） was intravenously given to those in the normal saline group. Postoperatively, the patients in the two groups were offered a patient controlled intravenous analgesia （PCIA） pump, in which, sufentanil （150μg） and tropisetron （5 mg） were diluted with normal saline to 120 mL, the solution was intravenously dripped for 48 hours at a velocity of 2.0 mL/h. A comparison was carried out between the two groups with regard to the following items： the efficacy of brachial plexus block, the patients＇ tolerance on tourniquet, and postoperative analgesia, required time of pressing, effective pressing numbers, postoperative nausea and vomi- ting and itch of skin. Results The rates of effectiveness of brachial plexus anesthesia and tourniquet tolerance were higher in the ketamine group than the normal saline group （u=3.154,1. 986;P〈0.05）. The postoperative analgesia was satisfied in both the groups, and the visual analog scale （VAS） had no statistical difference. The requirement of postoperative pressing of PCIA and the numbers of its pressing in 48 hours after surgery in the ketamine group was lower than the normal saline group （t = 5.7,3.7;P 0.05）. The incidence of nausea and vomiting, and itch of skin was no significant difference between the two groups （P〉0.05）. Conclusion The effect of low-dose ketamine in perioperative balanced analgesia is remarkable for severed finger reunion, which raises the satisfaction rate of braehial plexus anesthesia and tourniquet tolerance, reduces the number

关 键 词：氯胺酮 臂丛 麻醉 传导 指 再植术 镇痛 

分 类 号：R614.4[医药卫生—麻醉学]