国际麻醉学与复苏杂志
國際痳醉學與複囌雜誌
국제마취학여복소잡지
INTERNATIONAL JOURNAL OF ANESTHESIOLOGY AND RESUSCITATION
2012年
1期
30-33,38
,共5页
瑞芬太尼%氯胺酮%疼痛%曲马多
瑞芬太尼%氯胺酮%疼痛%麯馬多
서분태니%록알동%동통%곡마다
Remifentanil%Ketamine%Pain%Tramadol
目的 观察小剂量氯胺酮辅助全身麻醉对术后疼痛的影响.方法 40例择期行腹部手术患者,ASA Ⅰ～Ⅲ级,年龄29岁～83岁,按随机数目表法随机分为两组,每组20例.氯胺酮组(KG组):诱导后氯胺酮0.5 mg/kg,持续泵注5μg·kg-1·min-1至手术结束；生理盐水对照组(CG组):持续泵注等容量的生理盐水.两组均采用咪达唑仑0.03 mg/kg、芬太尼2.0 μg/kg、维库溴铵0.1 mg/kg、丙泊酚l mg/kg～2 mg/kg相同的麻醉诱导；瑞芬太尼和七氟烷维持麻醉并至关腹时停用.记录监测:入室后、诱导前、诱导后、插管即刻、切皮、关腹和拔管时血流动力学变化和脑电双频指数(BIS)值；术毕清醒时间和拔管时间；术后不同时间点镇痛评分、曲马多用量.结果 KG组在拔管后第10、15分钟的口述描绘疼痛评分(verbal rating scales,VRS)比CG组低(2.3±0.6、2.8±0.8,P＜0.05;2.8±0.5、3.4±0.5,P＜0.01)；术后两组首次追加曲马多的时间比较,CG组明显提前(13.5±2.9、9.8±2.5,P＜0.05),两组复苏室曲马多累积用量组间比较差异有统计学意义(75±26、131±29,P＜0.01).结论 术中持续使用小剂量氯胺酮,能减轻术后疼痛评分,减少曲马多用量,提示小剂量氯胺酮对临床相关浓度瑞芬太尼所诱发的术后痛觉过敏具有预防作用.
目的 觀察小劑量氯胺酮輔助全身痳醉對術後疼痛的影響.方法 40例擇期行腹部手術患者,ASA Ⅰ～Ⅲ級,年齡29歲～83歲,按隨機數目錶法隨機分為兩組,每組20例.氯胺酮組(KG組):誘導後氯胺酮0.5 mg/kg,持續泵註5μg·kg-1·min-1至手術結束；生理鹽水對照組(CG組):持續泵註等容量的生理鹽水.兩組均採用咪達唑崙0.03 mg/kg、芬太尼2.0 μg/kg、維庫溴銨0.1 mg/kg、丙泊酚l mg/kg～2 mg/kg相同的痳醉誘導；瑞芬太尼和七氟烷維持痳醉併至關腹時停用.記錄鑑測:入室後、誘導前、誘導後、插管即刻、切皮、關腹和拔管時血流動力學變化和腦電雙頻指數(BIS)值；術畢清醒時間和拔管時間；術後不同時間點鎮痛評分、麯馬多用量.結果 KG組在拔管後第10、15分鐘的口述描繪疼痛評分(verbal rating scales,VRS)比CG組低(2.3±0.6、2.8±0.8,P＜0.05;2.8±0.5、3.4±0.5,P＜0.01)；術後兩組首次追加麯馬多的時間比較,CG組明顯提前(13.5±2.9、9.8±2.5,P＜0.05),兩組複囌室麯馬多纍積用量組間比較差異有統計學意義(75±26、131±29,P＜0.01).結論 術中持續使用小劑量氯胺酮,能減輕術後疼痛評分,減少麯馬多用量,提示小劑量氯胺酮對臨床相關濃度瑞芬太尼所誘髮的術後痛覺過敏具有預防作用.
목적 관찰소제량록알동보조전신마취대술후동통적영향.방법 40례택기행복부수술환자,ASA Ⅰ～Ⅲ급,년령29세～83세,안수궤수목표법수궤분위량조,매조20례.록알동조(KG조):유도후록알동0.5 mg/kg,지속빙주5μg·kg-1·min-1지수술결속；생리염수대조조(CG조):지속빙주등용량적생리염수.량조균채용미체서륜0.03 mg/kg、분태니2.0 μg/kg、유고추안0.1 mg/kg、병박분l mg/kg～2 mg/kg상동적마취유도；서분태니화칠불완유지마취병지관복시정용.기록감측:입실후、유도전、유도후、삽관즉각、절피、관복화발관시혈류동역학변화화뇌전쌍빈지수(BIS)치；술필청성시간화발관시간；술후불동시간점진통평분、곡마다용량.결과 KG조재발관후제10、15분종적구술묘회동통평분(verbal rating scales,VRS)비CG조저(2.3±0.6、2.8±0.8,P＜0.05;2.8±0.5、3.4±0.5,P＜0.01)；술후량조수차추가곡마다적시간비교,CG조명현제전(13.5±2.9、9.8±2.5,P＜0.05),량조복소실곡마다루적용량조간비교차이유통계학의의(75±26、131±29,P＜0.01).결론 술중지속사용소제량록알동,능감경술후동통평분,감소곡마다용량,제시소제량록알동대림상상관농도서분태니소유발적술후통각과민구유예방작용.
Objective To observe the effect of combined general anesthesia with small-dose ketamine on postoperative pain.Methods Fourty patients aged 29 y-83 y(ASA Ⅰ-Ⅲ)scheduled for major abdominal surgery were randomly assigned to receive intraoperative low-dose ketamine(KG group,bolus dose of 0.5 mg/kg followed by continuous infusion of 5 μg·kg1·min-1)or an equal volume of saline(CG group)during remifentanil/sevoflurane anesthesia.Anesthesia was induced with midazolam 0.03 mg/kg,fentanyl 2 μg/kg,vecuronium 0.1 mg/kg,and propofol 1 mg/kg-2 mg/kg.The data of hemodynamics and Bispectral index of the electroencephalogram were recorded at following time points:before induction,after induction,intubation,skin incision,abdomen closure and extubation Awakening time and extubation time were recorded.Pain scores,sedation scores and postoperative tramodal consumption were recored as well.Results The VRS in KG group at 10,15 min after extubation were lower than that in CG group (2.3±0.6,2.8±0.8,P＜0.05; 2.8±0.5,3.4±0.5,P＜0.01).The first request for tramadol in CG group was earlier than in KG group (13.5±2.9,9.8±2.5,P＜0.05).Tramadol consumption in PACU of CG group was much more than that of KG group(75±26,131±29,P＜0.01).Conclusions Intraoperative low-dose ketamine infusion could lighten postoperative pain and decrease tramodal consumption.These data suggest that small-dose ketamine could prevent postoperative hyperalgesia induced by clinical concentrations of remifentanil.
