氯胺酮与吗啡配伍用于硬膜外术后镇痛

目的探讨氟胺酮与吗啡用于硬膜外术后镇痛的临床效果与不良反应。方法ASAⅠ～Ⅱ级90例择期妇科手术患者，随机分为A、B与C3组，每组30例，均采用腰麻一硬膜外联合阻滞。腰麻用药为0．5％重比重布比卡因10mg，然后硬膜外腔置管。A组于腰麻液中加入吗啡0．25mg，B组于硬膜外腔注入吗啡2mg，C组则于硬膜外腔注入吗啡2mg加氟胺酮1．2mg／kg。术后行视觉模拟评分（VAS），Ramsay镇静评分，BCS（bruggrmann comfortscale）舒适评分，并观察不良反应发生情况。结果C组与A组术后VAS评分均明显低于B组（P〈0．01、P〈0．05），差异有统计学意义。Ramsay评分和BCS评分两组明显高于B组（P〈0．01、P〈0．05），差异有统计学意义。A组术后不良反应发生率比其他两组明显增加（P〈0．01或P〈0．05）。而A组与C组相比较，两组术后VAS评分、Ramsay评分和BCS评分差异无统计学意义（P〉0．05）。结论硬膜外吗啡联用氯胺酮术后镇痛与蛛网膜下腔吗啡镇痛均有镇痛效果确切、持续时间长、术后镇静满意、患者感觉良好的优点，但硬膜外吗啡联用氯胺酮术后镇痛不良反应发生率明显低于蛛网膜下腔吗啡术后镇痛组，是一种更为切实可行的方法。

Epidural injection of morphine and ketamine for postoperative analgesia

Objective To study the analgesic effects and side effects of epidural injection of morphine and ketamine for postoperative pain-relief.Methods Ninety ASA I-II patients were randomly divided into three groups.Intrathecal group(group A,30 patients) received a spinal injection of bupivacaine with morphine 0.25mg.Epidural morphine group(group B,30 patients) received a spinal injection of bupivacaine and epidural morphine 2mg.Epidural morphine and ketamine group(group C,30 patients) received a spinal injection of bupivacaine and epidural morphine 2mg and ketamine 1.2mg/kg.The visual analogue scale(VAS) was assessed at 0-4,5-8,9-20,21-24,25-48h after operation,Ramsay sedation scores and Bruggrmann comfort scale(BCS) were done either at the same time points in three groups.The incidence of side effects was recorded.Results The VAS was significantly less in group A and C than those in group B(P<0.01 or P<0.05).Ramsay sedation scores and BCS were significantly higher in group A and C compared with those in group B(P<0.01 or P<0.05).The side effects was significantly increased in group A compared with those in group B and C.But there was no significant difference of the postperative visual analogue scale(VAS),Ramsay sedation scores and Bruggrrmann comfort scale(BCS) between the group A and group C(P>0.05).Conclusion Epidural injection of morphine and ketamine for postoperative analgesia is not only better than epidural morphine but also has less side effects than intrathecal morphine.