氯胺酮超前镇痛对雷米芬太尼苏醒期躁动的预防作用

目的探讨雷米芬太尼麻醉后苏醒期躁动的原因及预防方法。方法选择60例ASAⅠ～Ⅱ级择期腹腔镜下胆囊切除术的患者,随机分为A、B、C三组,每组20例。A组氯胺酮0.5mg/kg,B组氯胺酮1.5mg/kg,C组0.9%生理盐水5mL,每组1/3剂量在推注雷米芬太尼前给予,余下2/3剂量加入雷米芬太尼混合输注。记录全麻开始前5min(T_1)、给药后1 min(T_2)、给药后30 min(T_3)、术毕停药后5min (T_4)、拔管后1min(T_5)、拔管后20min(T_6)各时间点MAP、HR、SPO_2,以及患者拔管后1、3、6、12h的VAS视觉模拟评分,T_4、T_5、T_6、1h、3h躁动评分(RS)。结果三组各项指标T_(1～6)时MAP、HR、SPO_2 A、B组间差异无统计学意义,C组T_4、T_5、T_6时MAP、HR均高于A、B组(P<0.05)。患者苏醒后各时间点VAS视觉模拟评分、躁动评分(RS)A、B组间差异无统计学意义,C组明显高于A、B组(P<0.05)。结论雷米芬太尼苏醒期躁动可能与患者疼痛或痛觉高敏有关。氯胺酮超前镇痛预防雷米芬太尼麻醉后苏醒期躁动与所用氯胺酮剂量无关,效果确切,不良反应少。

The Preemptive Analgesic Effect of Ketamine Preventing the Restlessness During Emer-gence after Remifentanil-based General Anesthesia

Objective To investigate proposal preventing the restlessness during emergence after remifentanil-based general anesthesia. Methods Sixty ASA classⅠorⅡpatients undergoing elective laparoscopic cholecystectomy were randomly divided into A , B and C with 20 cases each.The patients in group A were injected ketamine 0.5mg/kg,and those in group B ketamine 1.5mg/kg were injected 1/3 of all dose before remifentanil was given,the rest were infused continuously with remifentanil. The patients in group C were given 0.9% NaC1.5mL. Results all data MAP,HR,SpO_2 at 5 rain befoe anesthesia (T_1), 1 rain (T_2) ,30 rain (T_3)after drug administration,5 min after the end of surgery (T_4),1 min (T_5) ,20 min(T_6) after extubation. VAS scores at 1,3,6,12 h after extubation and RS at T_4,T_5,T_6,1h,3h analgesic effect. Results The MAP,HR,SpO2 which was not significantly diffence between group A and group B at T_1 to T_6,it was significantly lower in group A and B than that in group C (P<0.05). VAS and RS of group A and B at T_1 to 12 h was significantly lower than that of group C (P<0.05). Conclusion The restlessness during emergence after remifentanil-based general anesthesia may be connective with pain or pain in patients with high sensitivity. Preemptive analgesia with ketamine can safely and perfectly prevent the restlessness during emergence after remifentanil-based general anesthesia,which produce few side effects.