小剂量氯胺酮辅助吗啡静脉自控镇痛用于妇科开腹患者术后的临床研究

目的探讨小剂量氯胺酮辅助吗啡静脉自控镇痛在妇科开腹手术术后中的临床效果及不良作用。方法将90例在硬膜外麻醉下接受全子宫切除术的患者随机分成三组：I组接受吗啡0．02mg／kg，U组接受吗啡0．15mg／kg＋氯胺酮0．04mg／kg，m组接受吗啡0．15mg／kg＋氯胺酮0．06mg／kg静脉术后镇痛治疗。并于术后6、12、24、36、48h记录疼痛评分、镇静评分和发生的不良反应（恶心、呕吐及瘙痒等）。结果Ⅲ组的疼痛评分在各时间点均明显低于I组和Ⅱ组（P〈0．05），而Ⅱ组和I组之间差异无统计学意义（P〉0．05）。三组之间的镇静评分差异无统计学意义（P〉0．05）。I组中恶心、呕吐、皮肤瘙痒明显高于Ⅲ和Ⅱ组，差异有统计学意义（P〈0．05）。结论在妇科开腹手术术后小剂量氯胺酮（0．06mg／kg）辅助吗啡静脉自控镇痛能够增强吗啡的镇痛作用，减少吗啡的用量，并能够减少其不良反应。

Continuous intravenous infusion of low dose of ketamine combined with morphine used for postoperative analgesia in patients undergoing abdominal gynecological surgery

Objective To explore the effect and the side - effect of continuous intravenous infusion of low dose of ketamine combined with morphine for postoperative analgesia in patients undergoing abdominal gynecological surgery. Methods Ninety patients undergoing abdominal gynecological surgery were randomly divided into three groups,group I （morphine, 0. 02 mg/kg）, group II （morphine, 0. 15 mg/kg ＋ ketamine, 0. 04 mg/kg）, and group III （morphine, 0. 15 mg/kg ＋ ketamine, 0. 06 mg/kg）, to accept intravenous postoperative analgesia. The pain scores of VAS, sedation scores, the incidence of side -effects including pruritus, nausea and vomiting were recorded at 6,12,24,36,48 h after operation. Results The pain score of group m at each time point was significantly lower than that of groupI and group II （ P 〈 0. 05） , and there was no significant difference between groupI and group II （ P 〉 0. 05）. There was no significant difference among the three groups on sedation scores （ P 〉 0. 05） , and the incidence of the nausea and vomiting and pruritus were significant higher in group I than that in group II and group III（ P 〈0. 05）. Conclusions 0. 06 mg/kg of ketamine can enhance the effect of morphine,lower the comsumption dosage of morphine, and decrease side -effect events.