小剂量氯胺酮围术期持续静注对食管癌开胸术后急性及慢性疼痛的影响研究

目的观察小剂量氯胺酮围术期持续静脉输注对食管癌开胸术后急性及慢性疼痛的影响。方法拟在全身麻醉联合硬膜外阻滞下行开胸食管癌根治术病人75例,ASAⅠ-Ⅱ。按数字表法随机将患者分为3组（n=25）：A组切皮前先缓慢静脉注射氯胺酮0.5mg/kg（0.9%氯化钠溶液稀释至5m l）然后接输注泵静脉持续输注氯胺酮0.05mg.kg-1.h-1至术后48h;B组切皮前缓慢静脉注射氯胺酮0.5mg/kg（0.9%氯化钠溶液稀释至5m l）和C组切皮前缓慢静脉注射0.9%氯化钠溶液5m。l全麻开始经T6~7硬膜外阻滞并检测阻滞平面。采用静脉注射异丙酚-舒芬太尼-维库溴铵诱导和维持麻醉。术后均采用0.125%布比卡因和舒芬太尼0.5μgom l行PCEA,维持VAS≤3。于术后6、12、24、48h时进行BCS舒适度评分,记录术后48h内舒芬太尼用量、不良反应情况,并追踪随访术后1、3、6个月的慢性疼痛持续情况。结果与C组比较,A组和B组术后48h内舒芬太尼的用量明显减少（P〈0.05）,术后48h内各时点BCS舒适度评分升高（P〈0.05）。术后1、3、6个月A组各时段VAS显著降低（P〈0.05）。3组镇静评分和不良反应发生率比较差异无统计学意义（P〉0.05）。结论小剂量氯胺酮围术期持续静脉输注减少食管癌开胸手术病人术后阿片类镇痛药用量,并且能够有效缓解开胸术后急慢性疼痛。

Effect of Continuous Intravenous Infusion Low-dose Ketamine in Perioperation for Acute and Chronic Pain of Postoperation in Esophagus Cancer Patients Undergoing Thorocic Surgery

Objective To investigate the effect of continuous continuous infusion of low-dose ketamine in perioperation for acute and chronic pain of postoperation in esophagus cancer patients undergoing thorocic surgery.Methods Seventy-five ASA Ⅰ～Ⅱ patients,aged 56～77yr,scheduled for thorocic surgery under general anesthesia combined with thoracic epidural block,were Randomly divided into 3 group（n=25 each）:group A,group B,and group C.Epidural anesthesia was performed at the T6～7 intervertebral space before general anesthesia.Anesthesia was induced with sufentinil 3～4μg·kg^-1,vecuronium 0.12mg·kg^-1,propofol 1～1.5 mg·kg^-1.Double-lumen tube was inserted and the patients were mechanically ventilated.Group A received iv ketamine sodium 0.5mg·kg^-1 2 minutes before skin incision and then infused ketamine sodium 0.05mg·kg^-1·h^-1 until 48h after the operations.Group B received ketamine sodium 0.5mg.kg-1 2 min before skin incision only.Group C received normal saline 5ml 2 min before skin incision only.Anesthesia was maintained with propofol、sufentanil、vecuronium and lidocaine.All the groups were given patients-controlled analgesia﹙PCEA﹚with sufentanil 0.5μgoml-1 and 0.125% bupivacaine,the visual analogne scale（VAS） was kept ≤ 3.The comfort level was evaluated with Bruggrmann comfort scale﹙BCS﹚at 6h,12h,24h,48h after operation respectively.The comsumption of sufentanil and adverse reation were recorded for 48h after surgery.The patients was followed up in 1 month,3month and 6month to assess the chronic pain.Results Compared with group C,The comsumption of sufentanil was decreased significantly in groupA and groupB with 48h（P<0.05）,the BCS was significantly increased at each time point（P<0.05）.Compared with group B and group C,the VAS was reduced in 1 mon,3 mon and 6 mon respectively in group A after surgery（P<0.05）.There was no significant difference in the sedation and adverse reaction among the three groups（P>0.05）.Conclusion Continuous intravenous low-dose ketamine infusion in peri-operational period can significantly relieve the acute and chronic post-operation and reduce postoperative sufentanil consumption in esophagus cancer patients undergoing thoracic surgery.