小剂量氯胺酮对布托啡诺患者自控静脉镇痛的影响

目的探讨小剂量氯胺酮对上肢手术后布托啡诺病人自控静脉镇痛（PCIA）效果的影响。方法选择在臂丛神经阻滞下行择期上肢手术的患者50例,随机分为两组（n=25）：即B组（布托啡诺10 mg＋氟哌利多5 mg）和BK组（布托啡诺10 mg＋氟哌利多5 mg＋氯胺酮200 mg）。两组均用生理盐水稀释至150 ml,于术毕前1 h静注布托啡诺1mg作为负荷剂量后连接PCIA泵,背景输注速率2 ml/h,按压单次给药剂量0.5 ml,锁定时间15 min,镇痛时间48 h。观察和记录术后4 h、8 h、12 h、24 h、36 h、48 h的疼痛评分（VAS）、镇静评分（Ramsay）、生命体征、SpO2。VAS评分〉5时静注哌替啶25 mg。记录术后48 h自控镇痛的有效按压次数、镇痛泵药液消耗量及哌替啶的用量。同时观察和记录患者呼吸抑制、恶心呕吐等不良反应的发生情况。结果两组术后各时间点VAS评分均低于5分,Ramsay镇静评分均为2,镇静满意。与B组相比,BK组VAS评分降低,并在术后4 h、8 h、12 h差异有统计学意义（P〈0.05）;BK组在术后48 h内使用自控镇痛的有效次数及镇痛泵药液消耗量更少（P〈0.05）。两组术后不良反应的发生率差异无统计学意义（P〉0.05）。结论小剂量氯胺酮可增强上肢手术后布托啡诺病人自控静脉镇痛的效果,明显优于单纯布托啡诺组,且不增加不良反应的发生,值得临床推广应用

Effect of Small Dose Ketamine on Efficacy of PCIA with Butorphanol after Upper Limbs Surgery

Objective To evaluate the effect of small dose ketamine on the efficacy of patient controlled intravenous analgesia（PCIA） with butorphanol after upper limbs surgery.Methods Fifty patients undergoing brachial plexus block scheduled for upper limbs srugery were randomly divided into 2 groups（n=25） according to the composition of PCIA solution.Group B： butorphanol 10 mg ＋ droperidol 5 mg in 150 ml of normal saline;group BK： butorphanol 10 mg＋droperidol 5 mg ＋ ketamine 200 mg in 150 ml of normal saline.Both groups were injected with butorphanol 1 mg as a loading dose at 1h before termination of surgery.The PCIA setting was as following： background infusion 2 ml/h,bolus dose 0.5 ml,lockout interval 15 min and the total analgesia time 48 h.In the postoperative period,pain was assessed using visual analogue scores（VAS） at 4 h,8 h,12 h,24 h,36 h and 48 h.If VAS score was 〉5,pethidine 25 mg was injected.The total amount of effectively pressing patient-controlled button,the PCIA solution and pethidine were given within 48 h after operation,Ramsay scores and postoperative complications including respiratory depression,nausea and vomiting,et al were recorded.All patients received SP,DP,HR,RR and SpO2 monitoring.Results VAS of the two groups were 〈5 at each of the assessment and Ramsay of both were 2 which means perfect sedation.VAS was lower in group BK than that in group B,but the difference was significant at 4 h,8 h and 12 h（P〈0.05）.The total amount of effectively pressing patient-controlled button and the PCIA solution given within 48 h after operation in group BK was much less than that in group B（P〈0.05）.There were no between-group difference in the postoperative complications（P〉0.05）.Conclusion Samll dose ketamine can improve the efficacy of PCIA with butorphanol after upper limbs surgery with no significant adverse effect,it was superior to butorphanol,.Therefore,it was worth popularizing and applying in clinic.