小剂量氯胺酮复合芬太尼在小儿术后镇痛中的应用

目的：评价小剂量氯胺酮复合芬太尼在小儿上肢手术术后镇痛中的应用效果。方法：择期全麻下行上肢手术患儿60例,年龄3-9岁,随机分为两组,与手术封皮时经静脉连接镇痛泵,镇痛液配方：F组（芬太尼0.02mg·kg^-1＋昂单司琼0.1mg·kg^-1＋生理盐水=100m L）;KF组（氯胺酮4mg·kg^-1·d^-1＋芬太尼0.01mg·kg^-1＋昂单司琼0.1mg·kg^-1＋生理盐水=100m L）。记录术后4、8、12、24、36h的疼痛VAS评分和Ramsay镇静评分,观察和记录不良反应发生情况。结果：F组Ramsay评分明显低于KF组,且KF组恶心、呕吐、皮肤瘙痒发生率明显降低;术后8h后KF组VAS评分明显低于F组。结论：小剂量氯胺酮复合芬太尼用于小儿术后镇痛效果肯定,且不良反应发生率低。

The Usage of Small-dose Ketamin and Fentanyl for Postoperative Analgesia in children

Objective：To observe the effects of small-dose ketamin and fentanyl on postoperative analgesia in children underwent upper limb operations. Methods： Sixty patients （ASA Ⅰ or Ⅱ）, aged 6 to 9 years old, underwent upper limb operation were randomly divided into two groups. Patients controlled intravenous analgesia（PCIA）was started since skin suture with the following composition：fentanyl 0.02 mg·kg^-1＋ondansetron 0.1mg·kg^-1 in 0.9%NS 100ml （group F）？ fentanyl 0.01mg·kg^-1＋ondansetron 0.1mg·kg^-1＋ ketamine 4mg·kg^-1 in 0.9%NS 100ml（group KF）.Visual analogue scale（VAS）pain scales and Ramsay sedation scores were recorded at 4、8、12、24 and 36 h after operation,and side effects were observed and recorded.Results： Ramsay score increased significantly in group F compared with that of group KF （P〈0.05）.Otherwise,the incidence of side effects was significantly decreased in group KF compared with group F （P〈0.05）.VAS value decreased in groups KF at 6-36h postoperatively compared with group K （P〈0.05）.Conclusion：Small dose of ketamine can improve the fentanyl postoperative analgesic efficacy in children with upper limb operation,without increasing the incidence of side effects.