小剂量氯胺酮预防瑞芬太尼麻醉后急性疼痛的作用

目的研究小剂量氯胺酮对瑞芬太尼麻醉术后急性疼痛的预防作用。方法60例在瑞芬太尼复合静脉全麻下行择期腹部外科手术病人，随机分为三组，A组于切皮前，B组于术毕前20min，静注氯胺酮0．5mg／kg（5ml），C组（对照组）注射同等容量的生理盐水，观察苏醒及术后疼痛情况。结果三组拔管时间及不良事件发生率无差异，B组镇静评分较高，术后仅拔管后15min和1h疼痛评分B组高于另两组，余时间点无差异，术后要求镇痛人数及曲马多的总需要量各组比较无差异。结论小剂量氯胺酮不能预防瑞芬太尼麻醉后痛觉过敏。

Effects of small-dose ketamine on postoperative hypergesia after remifentanil anesthesia.

Objective To determine if small-dose ketamine can prevent postoperative hypergesia after remifentanil anesthesia.Methods Sixty ASAⅠorⅡpatients underging major abdominal surgery under remifentanil-propofol anesthesia were randomly assigned to three groups . Group A received a bolus of ketamine 0.5 mg·kg-1before skin incision ,and group B were given the same treatment twenty minutes before the end of surgery, group B received same volume of soline instead . Trachea extubation time and complications are recorded . The visual analogue scale of fifteen minutes after trachea extubation and 1,2,4,6hour after operation were evaluated .The number of patients requring analgesia within 6 hours and those demanding analgesia drugs again within 6 hours after operation were recorded. The tramdol consumption were compared too.Results There were no difference of trachea extubation time and complications in three groups . The VRS score of 15 minutes and VAS score of 1 hour after operation in group B were higher than other two groups .But on other times ,we found no difference . Patients requring analgesia and tramdol consumption of three groups within 6 hours were similar.Conclusion Small-dose ketamine can not prevent hypergesia after remifentanil anesthesia.