小剂量氯胺酮对瑞芬太尼诱发的麻醉后寒战的影响

目的探讨小剂量氯胺酮对瑞芬太尼诱发的麻醉后寒战是否有改善作用。方法选择ASAⅠ～Ⅱ级的择期腰椎手术患者80例,予以瑞芬太尼复合丙泊酚全凭静脉麻醉,将患者随机等分为M、MK两组,M组吗啡20μg/（kg.h）,MK组为吗啡15μg/（kg.h）＋氯胺酮70μg/（kg.h）静脉术后镇痛治疗,于手术结束前半小时均以一次性镇痛泵（1 ml/h）行静脉术后镇痛,并予以负荷剂量3 ml。于拔管后30min内记录患者发生麻醉后寒战的例数,及该时点的疼痛评分、心率、平均压。结果两组患者一般情况、疼痛评分、心率、平均压无统计学差异（P〉0.05）,MK组寒战例数明显少于M组（P〈0.05）。结论小剂量氯胺酮用于术后镇痛,并于手术结束前约半小时预镇痛,可减少麻醉后寒战的发生率。

Effect of small dose of Ketamine on Remifentanil-induced postanesthetic shivering

Objective To evaluate whether the small dose of Ketamine has the improving function in Remifentanil-induced postanesthetic shivering. Methods Eighty patients undergoing general anesthesia for lumbar spine surgery were divided randomly into 2 groups, group M morphine 20 ug/（ kg.h） ], group MK morphine 15ug/（ kg. h） ＋ ketamine 70ug/（ kg. h） ], to accept intra- venous postoperative analgesia. 3 ml physic liquor was intravenous injected at 30min before the end of operation, followed by 1 ml/h intravenous infusion. Shivering,heart rate （HR） , score of pain and mean arterial pressure （MAP） were observed at 30min after operation. Results The general condition, MAP, score of pain and HR has no statistically significant difference between two groups. The shivering occurred in group MK was more than in group M （ P 〈 0.05 ）. Conclusion Small dose of ketamine used in postoperative analgesia and preemptive analgesia at 30min before the end of operation can reduce the rate of remffentanil-induced postanesthetie shivering.