亚麻醉剂量氯胺酮复合布托啡诺用于妇科患者术后静脉镇痛的比较

目的:比较3种不同剂量氯胺酮复合用于布托啡诺术后持续泵入静脉镇痛的有效性和安全性,为临床使用确定一个合适的剂量.方法:80例ASA(American Society of Anesthesiologists,美国麻醉医师协会)Ⅰ～Ⅱ级的择期妇科手术病人,随机分为4组,每组20例.B组:3μg/(kg·h)的布托啡诺;BK1组:2μg/(kg·h)的布托啡诺和60 μg/(kg·h)的氧胺酮;BK2组:2 μg/(kg·h)的布托啡诺和90 μg(kg·h)的氯胺酮;BK3组:2μg/(kg·h)的布托啡诺和120 μg/(kg·h)的氯胺酮.应用持续泵入镇痛给药模式,总量100 mL,负荷量4 mL,持续输注2 mL/h.手术后感觉疼痛明显时(视觉模拟评分5分左右)启动镇痛泵.观察各组在镇痛泵开始后2,6,12,24,48 h各时间点的镇痛评分、Ramsay镇静评分和不良反应.结果:4组患者48 h内血压、心率、呼吸、脉搏氧饱和度稳定,各组间副反应差异无统计学意义.术后各时间点VAS评分中以BK3组最低,其次为BK2组,BK组与B组相当.Ramsay镇静评分中B组嗜睡的发生率高于BK1,BK2和BK3组,且与BK2和BK3组的镇静评分差异有统计学意义(P＜0.05).结论:病人术后布托啡诺持续泵入静脉镇痛中辅助用氯胺酮可使镇痛、镇静效果更完善,可减少布托啡诺的用量,且无不良反应增加,其合理的配伍剂量为90～120 μg/(kg·h).

Three subanaesthetic dose ketamines mixed with butorphanol in the postoperative continuous intravenous analgesia

OBJECTIVE: To determine an optimal clinical dose of ketamine after comparing the efficacy and security of 3 low dose ketamines mixed with butorphanol in the postoperative continuous intravenous analgesia. METHODS: Eighty ASA (American Society of Anesthesiologists) I-II patients scheduled for elective gynecological surgery under general anesthesia were divided randomly into 4 groups (n=20): Group B received butorphanol 3 microg/(kg x h);Group BK1 received butorphanol 2 microg/(kg x h) mixed with ketamine 60 microg/(kg x h); Group BK2 received butorphanol 2 microg/(kg x h) mixed with ketamine 90 microg/(kg.h); and Group BK3 received butorphanol 2 microg/(kg x h) mixed with ketamine 120 microg/(kg x h). Continuous intravenous infusion pump was used when the patients had obvious pain (visual analgesia scale of five), and the bolus infusion (4 mL) was given before the operation, and continuous infusion at 2 mL/h. In the postoperative period, pain was assessed using visual analogue scale (VAS) at 2,6,12,24, and 48 h.At the same time, Ramsay scores and adverse effects were recorded. RESULTS: There was no significant difference in the adverse effects and the postoperative mean arterial pressure, heart rate, respiratory rate values, and pulse oxygen among the 4 groups. Postoperative VAS values in Group BK3 was the lowest, followed by Group BK2. There was no significant difference between Group BK1 and Group B. The incidence of somnolence in Group B was higher than that in Group BK1, BK2 and BK3(P<0.05). CONCLUSION: Ketamine in subanaesthetic dose added to butorphanol for postoperative continuous intravenous infusion has a better postoperative analgesic effect and sedation. It can effectively spare butorphanol consumption without increasing adverse effects. The optimal combined dose is 90-120 microg/(kg x h).