芬太尼联合氯胺酮用于术后镇痛的研究

目的比较小剂量氯胺酮联合芬太尼在术后静脉镇痛中的临床效应及副作用的发生率,并探讨氯胺酮的合适剂量。方法将150例行腹部及四肢脊柱手术患者随机分成3组,每组50例,均以一次性镇痛泵(1 ml/h)行静脉术后镇痛。F组芬太尼0.3μg/(kg.h),FK1组芬太尼0.2μg/(kg.h)+氯胺酮40μg/(kg.h),FK2组芬太尼0.2μg/(kg.h)+氯胺酮70μg/(kg.h)静脉术后镇痛治疗。分别于手术结束后12、24、36、48、60 h记录疼痛、镇静评分、发生的不良反应(瘙痒、恶心呕吐、精神症状)、血氧饱和度。结果FK2组的疼痛评分在各时间点均明显低于F组和FK1组在相同时间点的疼痛评分(P<0.05),而F组和FK1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)。三组中F组恶心、呕吐(16.0%)的发生率较高,但是三组之间差异无统计学意义(P>0.05)。三组中均未出现具有精神症状的病例。三组的血氧饱和度值在各时间点均不低于96%,而且三组之间差异无统计学意义(P>0.05)。结论70μg/(kg.h)氯胺酮在静脉术后镇痛中能够增强芬太尼[0.2μg/(kg.h)]的镇痛作用,而且不增加副作用。

Continuous Intravenous Infusion of Low Dose of Ketamine Combined with fentanyl Used for Postoperative Analgesia

Objective To evaluate the effect and the side-effect of continuous intravenous infusion of low dose of ketamine combined with fentanyl for postoperative analgesia,and to determine the suitable dosage of ketamine.Methods One hundred and fifty postoperative patients were randomly divided into three groups with 50 cases each.Intravenous postoperative analgesia was administered to Group F(fentanyl 0.3 g/kg·h),Group FK1(fentanyl 0.2 g/kg·h + ketamine 40 g/kg·h),and Group FK2(fentanyl 0.2 g/kg·h + ketamine 70 g/kg·h).The parameters,such as pain score of VAS,sedation score,incidence of side-effect including itch,nausea,vomiting and central excitatory phenomena,and saturation of pulse oxygen(SpO2) were recorded respectively at 12,24,36,48,and 60 hours after operation.Results The pain score of Group FK2 at each time point was significantly lower than that of Group F or Group FK1(P<0.01),and there was no significant difference between Group F and Group FK1(P>0.05).There were not significant differences in sedation score among the three groups(P>0.05).No significant differences were found in the incidence of nausea,vomiting,or itching among these groups(P>0.05),although that of nausea and vomiting(18.0 %) was a little higher in Group F.No case with central excitatory phenomena was found in each group.At each time point,no significant difference in SpO2 was found among these groups groups(P>0.05),and all the SpO2 values were not less than 96%.Conclusion Ketamine at 70 g/kg·h can enhance the efficacy of fentanyl(0.2 g/kg·h) without increasing side-effect events.