中国基层医药
中國基層醫藥
중국기층의약
CHINESE JOURNAL OF PRIMARY MEDICINE AND PHARMACY
2009年
1期
16-17
,共2页
氯胺酮%可乐定%镇痛%儿茶酚胺
氯胺酮%可樂定%鎮痛%兒茶酚胺
록알동%가악정%진통%인다분알
Katamine%Clonidine%Analgesia%Cate-cholamine
目的 观察氯胺酮复合可乐定超前镇痛的临床效果及对围手术期应激变化的影响.方法 36例子宫肌瘤患者在硬膜外麻醉下行子宫次全切除术,随机分为三组:Ⅰ组(对照组)不行超前镇痛,常规2%利多卡因3～4 ml实验剂量后,待平面确定后再注入4～5 ml,5 min后再注入5 ml;Ⅱ组切皮前30 min随实验剂量加入0.6 mg/kg氯胺酮,余同Ⅰ组;Ⅲ组切皮前30 min随实验剂量加入0.6 mg/kg氯胺酮+1.5 μg/kg可乐定,余同Ⅰ组.每组于人室手术前(T0)、术毕(T1)、术毕24 h(T2)、术毕48 h(T3)测血浆去甲肾上腺素(NE)、肾上腺素(E),记录术后2 h,4 h,6 h、12 h、24 h的VAS评分,术后每5分钟用针刺法记录感觉、运动恢复时间(以踝关节抬起为准)及术后头晕、恶心、呕吐、多语、呼吸抑制等不良反应.结果 VAS评分Ⅰ组术后24 h内高于Ⅱ组和Ⅲ组(P<0.05或P<0.01),Ⅱ组与Ⅲ组相比术后6～12 h差异有统计学意义.围术期E、NE变化Ⅱ、Ⅲ组与Ⅰ组比较在T1、T2、T3差异有统计学意义(P<0.05或P<0.01),Ⅱ组与Ⅲ组在T1、T2、T3差异有统计学意义(P<0.05).Ⅲ组的感觉、运动恢复时间与Ⅰ、Ⅱ组比较差异有统计学意义(P<0.01).结论 氯胺酮复合可乐定超前镇痛用于下腹部手术可显著减轻疼痛,减轻儿茶酚胺的增高反应,且不增加不良反应.
目的 觀察氯胺酮複閤可樂定超前鎮痛的臨床效果及對圍手術期應激變化的影響.方法 36例子宮肌瘤患者在硬膜外痳醉下行子宮次全切除術,隨機分為三組:Ⅰ組(對照組)不行超前鎮痛,常規2%利多卡因3～4 ml實驗劑量後,待平麵確定後再註入4～5 ml,5 min後再註入5 ml;Ⅱ組切皮前30 min隨實驗劑量加入0.6 mg/kg氯胺酮,餘同Ⅰ組;Ⅲ組切皮前30 min隨實驗劑量加入0.6 mg/kg氯胺酮+1.5 μg/kg可樂定,餘同Ⅰ組.每組于人室手術前(T0)、術畢(T1)、術畢24 h(T2)、術畢48 h(T3)測血漿去甲腎上腺素(NE)、腎上腺素(E),記錄術後2 h,4 h,6 h、12 h、24 h的VAS評分,術後每5分鐘用針刺法記錄感覺、運動恢複時間(以踝關節抬起為準)及術後頭暈、噁心、嘔吐、多語、呼吸抑製等不良反應.結果 VAS評分Ⅰ組術後24 h內高于Ⅱ組和Ⅲ組(P<0.05或P<0.01),Ⅱ組與Ⅲ組相比術後6～12 h差異有統計學意義.圍術期E、NE變化Ⅱ、Ⅲ組與Ⅰ組比較在T1、T2、T3差異有統計學意義(P<0.05或P<0.01),Ⅱ組與Ⅲ組在T1、T2、T3差異有統計學意義(P<0.05).Ⅲ組的感覺、運動恢複時間與Ⅰ、Ⅱ組比較差異有統計學意義(P<0.01).結論 氯胺酮複閤可樂定超前鎮痛用于下腹部手術可顯著減輕疼痛,減輕兒茶酚胺的增高反應,且不增加不良反應.
목적 관찰록알동복합가악정초전진통적림상효과급대위수술기응격변화적영향.방법 36례자궁기류환자재경막외마취하행자궁차전절제술,수궤분위삼조:Ⅰ조(대조조)불행초전진통,상규2%리다잡인3～4 ml실험제량후,대평면학정후재주입4～5 ml,5 min후재주입5 ml;Ⅱ조절피전30 min수실험제량가입0.6 mg/kg록알동,여동Ⅰ조;Ⅲ조절피전30 min수실험제량가입0.6 mg/kg록알동+1.5 μg/kg가악정,여동Ⅰ조.매조우인실수술전(T0)、술필(T1)、술필24 h(T2)、술필48 h(T3)측혈장거갑신상선소(NE)、신상선소(E),기록술후2 h,4 h,6 h、12 h、24 h적VAS평분,술후매5분종용침자법기록감각、운동회복시간(이과관절태기위준)급술후두훈、악심、구토、다어、호흡억제등불량반응.결과 VAS평분Ⅰ조술후24 h내고우Ⅱ조화Ⅲ조(P<0.05혹P<0.01),Ⅱ조여Ⅲ조상비술후6～12 h차이유통계학의의.위술기E、NE변화Ⅱ、Ⅲ조여Ⅰ조비교재T1、T2、T3차이유통계학의의(P<0.05혹P<0.01),Ⅱ조여Ⅲ조재T1、T2、T3차이유통계학의의(P<0.05).Ⅲ조적감각、운동회복시간여Ⅰ、Ⅱ조비교차이유통계학의의(P<0.01).결론 록알동복합가악정초전진통용우하복부수술가현저감경동통,감경인다분알적증고반응,차불증가불량반응.
Objective To observe the preemptive analgesia effects of katamine and elonidine, and to find out the influence of preemptive on stress responses. Methods 36 patients with hysteromyoma undergone hysteromyomec-tomy were randomly assigned to three groups (n = 12 each group) :group Ⅰ , control group, without preemptive analge-sia,the patients in control group were given continous epidural analgesia with 2% lidoeaine 12 - 14ml. Group Ⅱ ,the patients were injected 0. 6mg/kg katamine into epidural analgesia 30 minutes before operation. Group Ⅲ,the patients were injected 0. 6mg/kg katamine and 1.5μg/kg clonidine into epidural analgesia 30 minutes before operation. The patients in three groups were recorded VAS score on 2h ,4h ,6h, 12h ,24h after operation, also recorded the change of epinephrine(E) and norepinephrine(NE) and sensation and movement recovery time after operation. The side effects such as dizziness nausea,vomit,and exited talking were observed during the operation. Results The VAS score were significantly different between group Ⅰ ,Ⅱ and Ⅲ. The levels of E and NE in plasma in group Ⅰ were increased more than group Ⅱ and Ⅲ within 24 hours after operation, also there is significant difference in group Ⅱ compared with group Ⅲ in T1 ,T2 ,T3. The time of sensation and movement recovery were remarkably longer in group Ⅲ com-pared with group Ⅰ and Ⅱ, showing significant difference. There were no significant difference in side effects after operation in three groups. Conclusion The preemptive analgesia of kutamine and colnidine can relieve the pain of lower abdominal surgery and stress response after operation,and it do not increase the side effects.
