术后硬膜外应用小剂量氯胺酮对吗啡静脉镇痛的影响

目的:探讨硬膜外应用小剂量氯胺酮对吗啡静脉镇痛效果及不良反应的影响。方法:选择美国麻醉医师协会(ASA)I~II级且择期行肝脏切除手术的患者45例,随机分为对照组(C组)、实验组1(K组)、实验组2(KN组),每组15例。C组患者术后硬膜外应用0.9%氯化钠注射液4 mL;K组应用含0.1 mg/kg氯胺酮的0.9%氯化钠注射液4mL;KN组应用含0.1mg/kg氯胺酮和5μg/kg纳洛酮混合液的0.9%氯化钠注射液4 mL。硬膜外给药后,3组均开始应用吗啡静脉镇痛泵,并记录和比较3组术后3 h、6 h、12 h、24 h的吗啡消耗量、视觉模拟评分法(visual analogue scale/score,VAS)评分、恶心/呕吐次数、呼吸抑制、深度镇静及晕眩情况。结果:K组和KN组患者术后3 h的VAS评分与C组比较,差异无统计学意义(P0.05);K组和KN组术后6 h、12 h、24 h的VAS评分低于C组(P0.05)。K组和KN组患者术后3 h吗啡消耗量与C组相比差异无统计学意义(P0.05);K组和KN组术后6 h、12 h、24 h吗啡消耗量低于C组(P0.05)。K组术后12 h的恶心呕吐发生次数少于C组(P0.05);KN组术后3 h、6 h、12 h、24 h的恶心/呕吐次数均少于C组(P0.05)。各组患者在观察期间均未出现呼吸抑制和深度镇静,晕眩病例散发。结论:术后硬膜外应用小剂量氯胺酮可增强吗啡的静脉镇痛效果,减少吗啡消耗量及患者的恶心呕吐次数。

Effects of Low-Dose Ketamine via Epidural Injection on the Intravenous Analgesic Efficacy of Morphine after Operation

Objective：To evaluate the effect of low-dose ketamine via epidural injection on the intravenous analgesic efficacy of morphine after operation. Methods： Forty-five patients with American Society of Anesthesiologists（ASA）grade Ⅰ or If undergoing selective operation of hepalobectomy were randomized into Group C（0.9% NaCl 4 mL, epidural injection）, Group K（0. 1 mg/kg ketamine in 0.9% NaCl 4 mL, epidural injection）, Group KN（0.1 mg/kg ketamine ＋ 5μg/kg naloxone in 0.9% NaCl 4 mL, epidural injection）. And then, patient-controlled intravenous analgesia（PCIA） with morphine was started and recorded. The visual analogue scale/score （VAS）, morphine consumption, and the adverse reactions of morphine （nausea, vomiting, respiratory depression, deep sedation, dizziness） at the time points of 3 h, 6 h, 12 h, 24 h after operation were compared among the 3 groups. Results： Compared with Group C, the morphine consumption and VAS were statistically lower in Group K and Group KN at 6 h, 12 h, 24 h after operation. The times of nausea and vomiting at 12 h in Group K and at 3 h, 6 h, 12 h, 24 h in Group KN were less than those in Group C, but other adverse reactions in each group were not statistically analyzed. Conclusions： Low-dose ketamine via epidural injection can enhance the analgesia efficacy of morphine, decrease the comsuption of morphine, and reduce the nausea and vomiting times.