CAJ | 학술논문

目的：评价应用小剂量氯胺酮缓解颌面部手术瑞芬太尼麻醉后痛觉过敏的有效性和安全性。方法择期全麻下颌面部手术患者80例,随机分为氯胺酮组(n=40)和对照组(n=40),均采用静吸复合全身麻醉。静脉注射咪唑安定、丙泊酚、芬太尼和罗库溴铵麻醉诱导后,气管插管行机械通气。麻醉维持采用瑞芬太尼0．1~0．2ug/kg/min泵注,吸入七氟醚2%~3%,间断给予罗库溴铵维持麻醉。分别于缝皮时静脉给予0．5mg/kg氯胺酮(氯胺酮组)和相同剂量的生理盐水(对照组)。记录两组患者拔管时间、苏醒时间及再次要求镇痛的患者例数、曲马多用量和不良事件的发生情况。分别于苏醒后15min(T1)、30min(T2)、60min(T3)、120min(T4)进行 VAS、Ramsay评分。结果两组患者拔管时间、苏醒时间比较差异无统计学意义( P>0．05)。氯胺酮组要求镇痛人数(17/40)和曲马多用量(40．5mg)均低于对照组(25/40,70．6mg)(P<0．05)。患者苏醒后15min Ramsay评分氯胺酮组显著大于对照组(P<0．01),30min VAS评分对照组显著高于氯胺酮组(P<0．05)。两组患者不良反应无显著差异。结论颌面部手术瑞芬太尼麻醉后使用小剂量氯胺酮,可以有效缓解瑞芬太尼所致的痛觉过敏,无不良反应,临床应用安全可靠。
목적：평개응용소제량록알동완해합면부수술서분태니마취후통각과민적유효성화안전성。방법택기전마하합면부수술환자80례,수궤분위록알동조(n=40)화대조조(n=40),균채용정흡복합전신마취。정맥주사미서안정、병박분、분태니화라고추안마취유도후,기관삽관행궤계통기。마취유지채용서분태니0．1~0．2ug/kg/min빙주,흡입칠불미2%~3%,간단급여라고추안유지마취。분별우봉피시정맥급여0．5mg/kg록알동(록알동조)화상동제량적생리염수(대조조)。기록량조환자발관시간、소성시간급재차요구진통적환자례수、곡마다용량화불량사건적발생정황。분별우소성후15min(T1)、30min(T2)、60min(T3)、120min(T4)진행 VAS、Ramsay평분。결과량조환자발관시간、소성시간비교차이무통계학의의( P>0．05)。록알동조요구진통인수(17/40)화곡마다용량(40．5mg)균저우대조조(25/40,70．6mg)(P<0．05)。환자소성후15min Ramsay평분록알동조현저대우대조조(P<0．01),30min VAS평분대조조현저고우록알동조(P<0．05)。량조환자불량반응무현저차이。결론합면부수술서분태니마취후사용소제량록알동,가이유효완해서분태니소치적통각과민,무불량반응,림상응용안전가고。
Objective To evaluate the inhibiting effects of small-dose ketamine on postoperative hyperalgesia after remifentanil-based anaesthesia oromaxillo-facial surgery. Methods A total of 80 patients undergoing oral and maxillofacial surgery were randomly assigned to two groups, ketamine group ( n =40 ) and control group ( n =40 ) . Anesthesia was induced with midazolam,fentanyl,propofol and rocuronium and maintained with infusion of remifentanil (0. 1-0. 2μg/kg/min) and sevoflurane. The patients were mechanically ventilated after teacheal intubation. Ketamine was given before skin closing for inhibiting remifentanil-induced postoperative hyperalgesia in the ketamine group and saline given in the control group. The emergence time,trachea extubation time,VAS and Ramsay scores were recorded and the tramadol consumption were compared. Results There was no significant difference in trachea extubation time and emergence time between the two groups. The number of patients and tramadol consumption in ketamine group were significantly lower than those in control group. Pain VAS scores in control group were significantly higher than those in ketamine group 30 minutes after emergence ( P<0. 05). The Ramsay scores in control group 15 minutes after emergence were lower than those in ketamine group ( P<0. 01). The adverse drug reaction showed no significant difference between the two groups. Conclusion Small dose ketamine can prevent postoperative hyperalgesia after remifentanil-based anaesthesia without increasing the incidence of side effects.