硬膜外小剂量氯胺酮在不同给药时间的超前镇痛效果

目的观察硬膜外小剂量氯胺酮在不同给药时间的超前镇痛效果。方法60例行剖宫产术的病人随机分为3组,每组20例。分别在切皮前(A组)、手术后(B组)硬膜外注入氯胺酮30mg,切皮前硬膜外注入生理盐水1ml(C组),术后均采用硬膜外病人自控镇痛(PCEA)。观察术中平均动脉压(MAP)、心率(HR)、SpO2、新生儿Apgar评分,术后感觉疼痛时间、镇痛药用量、术后VAS评分和副作用。结果3组病人术中BP、HR、SpO2及新生儿Apgar评分皆无显著性差异(P>0.05)。术后疼痛开始时间,与C组比较,A组和B组均明显延长(P<0.01),A组和B组之间无显著性差异(P>0.05)。PCEA术后用药量依次为C组>B组>A组,3组间均有显著性差异(P<0.05)。患者术后排气时间及PCEA的VAS评分3组间无显著性差异(P>0.05)。与C组比较,A组和B组副作用发生率均显著降低(P<0.05),A组和B组之间无显著性差异(P>0.05)。结论硬膜外小剂量氯胺酮能降低术后病人PCEA时镇痛药的需要量,尤其切皮前用药更能有效地发挥超前镇痛作用。

The Efficacy of Preemptive Analgesia of Small Doses of Epidural Ketamine at Different Administration Time

Objective To observe the efficacy of preemptive analgesia of small doses of epidural injection with ketamine at different administration time.Methods Sixty patients undergoing cesarean section were randomly divided into 3 groups( n =20).Ketamine 30mg(group A) or saline 1ml(group C) was given by epidural injection before skin incision, or ketamine 30mg(group B) was injected postoperatively. MAP,HR,SpO_2,neonatal Apgar Scores in operation ,postoperative time of aching, the postoperative required analgesic dosage, incidences of side-effect and VAS score of PCEA were observed. Results The MAP,HR,SpO_2 and neonatal Apgar Scores in operation among three groups were no difference( P >0.05).The postoperative time of aching was significantly longer in group A and B than that in C( P <0.01),but not difference between the group A and B( P >0.05).The postoperative required analgesic dosage was obviously smaller in group A and B than that in C, but there was a significant increase in group B in comparison with A( P <0.05). The VAS scores of three groups were similar .The rates of nausea and vomiting were higher in group C than those in group A and B( P <0.05).Conclusion Small dose of epidural injection of ketamine can decrease the required analgesic dosage after operation.Epidural ketamine given before skin incision can produce preemptive analgesia more effectively than given postoperatively.