氯胺酮对术中应用芬太尼导致的术后吗啡需求增加的抑制作用

目的：旨在观察氯胺酮对术中应用芬太尼导致的术后吗啡需求增加的影响。方法：采用双盲方法将60例拟在腰麻下行开腹子宫切除术的患者随机分为4组：对照组（生理盐水，C）、芬太尼组（单次给予芬太尼1μg／kg，共3次，间隔15min，F）、氯胺酮组（切皮至手术结束前20min连续输注氯胺酮15μg·kg^-1·min^-1，K）、氯胺酮及芬太尼组（切皮至手术结束前连续输注氯胺酮15μg·kg^-1·min^-1；术中单次给予芬太尼1μg／kg，共3次，间隔15min，FK）。于术后1、3、6、12、24及48h记录累计吗啡需要量、痛觉评分及药物副作用（恶心、呕吐、幻觉、头晕、头痛及皮肤瘙痒）。结果：共60例患者入选本研究。4组患者的年龄、体重、手术持续时间及术后感觉阻滞时间差异无统计学意义。F组术后3、6、12h的累计吗啡需要量显著高于C组（P〈0．05）。C组、K组及FK组患者在术后各时间点的累计吗啡需要量差异无统计学意义。各组患者的术后痛觉评分差异无统计学意义。K组及FK组患者的术中及／或术后幻觉发生率显著高于C组（P〈0．05）。结论：本研究结果显示术中使用芬太尼可导致患者术后吗啡消耗量增加，而预先使用N-甲基-D-天门冬氨酸（NMDA）受体拮抗剂氯胺酮可预防芬太尼的以上作用。

Effects of ketamine on preventing the increase of postoperative morphine requirement induced by fentanyl

AIM: To observe the effects of ket-amine on preventing the increase of postoperative morphine requirement induced by fentanyl. METHODS: Sixty women undergoing total abdominal hysterectomy by spinal anaesthesia were assigned to 4 groups consisting of placebo ( normal saline, C) , fentanyl ( 3 bolus of 1 μg/kg, at 15 min intervals, F ) , ketamine (infusion of 15 μg·kg~(-1)·min~(-1) ketamine from the skin incision until 20 min before the end of the surgery, K), ketamine and fentanyl (infusion of 15 μg·kg~(-1)·min~(-1) ketamine from the skin incision until 20 min before the end of the surgery plus 3 bolus of 1μg/kg fentanyl, at 15-min intervals, FK). The cumulative morphine consumption , pain score, and adverse effects (nausea, vomiting, hallucination, dizziness and itching) were recorded at 1, 3, 6, 12, 24, 48 h postoperatively. RESULTS: There were no significant differences inage, weight, duration of surgery and the post-operative sensory block time. The cumulative morphine consumption in group F was significantly higher than those in group C at 3, 6, 12 h postoperatively ( P < 0.05). The postoperative cumulative morphine consumption was similar in group C, K and FK. No differences in posterative pain score were observed among the group. More patients in K and FK group had hallucination during and/or after the surgery than those in group C (P<0.05). CONCLUSION: These results suggested that intraoperative administration of fentanyl increased postoperative morphine consumption, which could be prevented by coadministration of ketamine.