氯胺酮在抑制瑞芬太尼麻醉后痛敏反应的临床应用

目的：探讨氯胺酮对瑞芬太尼麻醉所致痛敏反应的影响。方法：选取我院拟行腹部手术患者80例,美国麻醉协会（ASA）分级Ⅰ级或Ⅱ级,随机将其分为观察组（40例）与对照组（40例）,观察组应用瑞芬太尼麻醉同时加用氯胺酮0.5 mg/kg,继而5μg/（kg.min）静脉维持至手术结束,对照组未使用氯胺酮,比较术后1、2、4、8、24 h的视觉模拟评分（VAS）与警觉/镇静评分（OAA/S）、拔除气管插管时间、麻醉恢复室停留时间、加用镇痛药及不良反应情况。结果：观察组术后1、2、4、8 h患者VAS评分显著低于对照组,自控静脉镇痛泵按压次数、术后加用镇痛药物者显著少于对照组（P〈0.05或P〈0.01）,术后24 h,两组VAS评分、OAA/S评分、拔除气管插管时间、麻醉恢复室停留时间及不良反应情况在各时间点差异无统计学意义（P〉0.05）。结论：术中持续应用氯胺酮可有效预防瑞芬太尼麻醉后痛敏反应。

Clinical application on the inhibitory effect of Ketamine on the patients with post operative hyperalgesia after Remifentanil-based anaesthesia

Objective： To disscuss the effect of Ketamine on the patients with post operative hyperalgesia after Remifentanil-based anaesthesia.Methods： 80 patients who needed abdominal surgery,ASAⅠ or Ⅱ,were randomly divided into the control group and the observation group,40 patients in each group.The control group was given Remifentanil anesthesia only,without Ketamine,and the observation group was given Remifentanil anesthesia and Ketamine,then the VAS and OAA/S,time pull out tracheal intubation,anesthesia recovery room time and adverse reaction between the two groups were contrasted after operation in 1,2,4,8,24 h.Results： The VAS after operation in 1,2,4,8 h of the observation group were significantly lower than that of control group（P〈0.05 or P〈0.01）,analgesic pump used times and the patients who needed to add with analgesia drugs was significantly less than control group（P〈0.05 or P〈0.01）.24 h after operation,VAS,OAA/S,time pull out tracheal intubation,anesthesia recovery room time,and adverse reaction had no significant difference（P〈0.05）.Conclusion： Using Ketamine continuous in operation can effectively prevent the pain allergic after Remifentanil anesthesia.