小剂量氯胺酮防治瑞芬太尼麻醉后痛觉过敏的临床研究

目的 观察小剂量氯胺酮是否能抑制瑞芬太尼复合吸入麻醉所致的痛觉过敏.方法 腹腔镜下胆囊切除术患者60例,随机分为3组,对照组（C组）术中吸入麻醉七氨烷;瑞芬太尼组（R组）术中持续输注瑞芬太尼;氯胺酮组（K组）术中持续输注瑞芬太尼,缝皮时给予氯胺酮0.5 mg/kg.记录拔管后的口述疼痛评分与VAS评分.结果 R组和K组患者苏醒和拔管时间显著短于C组（P〈0.05）.术后R组口述疼痛评分与VAS显著高于K组和C组（P〈0.01）,R组要求镇痛者比较多.结论 小剂量氯胺酮对瑞芬太尼麻醉术后痛觉过敏具有明显的抑制作用,且不增加不良反应.

Low-dose ketamine for the prevention of hyperalgesia after remifentanil-based anesthesia

Objective To evaluate the preventive effects of low-dose ketamine on postoperative hyperalgesia a{ter large-dose remifentanil-based anesthesia. Methods Sixty patients undergoing laparoscopic cholecystectomy were randomly assigned to 3 groups （n = 20）. The patients in group R were received intraoperative remifentanil, in group K received intraoperative remifentanil and ket amine 0.5 mg/kg at skin closure, in group C only sevoflurane inhaled. The verbal rating pain score and VAS after extubation were recorded. Results The recovery time was significantly shorter in the group R and group K than that in group C （P〈0.05）. Verbal pain score and VAS in group R were significantly higher than those in group K and group C postoperatively （P〈0.01）. More patients in group R required analgesics than that in group C and group K. Conclusion Low-dose ketamine can attenuate postoperative hyperalgesia after large-dose remifentanil-based anesthesia.