摘要
目的评价氯胺酮持续皮下输注对舒芬太尼皮下自控镇痛(PCSA)效应的影响,探讨氯胺酮皮下辅助镇痛的最佳剂量。方法拟行腰椎内固定术患者200例,按照随机双盲原则均分为四组:K1、K2、K3组分别以0.5、1、2μg·kg-1·min-1持续输注氯胺酮,C组输注等量生理盐水。术后均行舒芬太尼皮下自控镇痛。比较术后8、24、48h舒芬太尼用量、静息时VAS评分及不良反应情况。结果术后8～48h,C组静息VAS评分均显著高于其它三组(P<0.05或P<0.01),而K3组显著低于K1、K2(P<0.01);K2、K3组舒芬太尼累积用量显著少于C组和K1组,且K3组显著少于K2组(P<0.01)。术后四组PONV发生率差异无统计学意义。K3组嗜睡发生率显著高于其它三组(P<0.05);K3组有8例(16%)复视,2例(4%)幻觉。结论氯胺酮1μg·kg-1·min-1可增强舒芬太尼PCSA效应,降低舒芬太尼需求量,且不良反应未有明显增加。
Objective To investigate the effect of continuous subcutaneous infusion（CSCI） of small-doses ketamine on patient-controlled subcutaneous analgesia（PCSA） with sufentanil.Methods In a randomized,double-blinded trial,200 patients,scheduled for lumbar vertebrae internal fixation,received PCSA sufentanil（background rate 30 ng·kg-1·h-1,bolus dose 30 ng/kg） with or without various dose of ketamine after emerging from anesthesia.Patients were randomly divided into four groups（n=50）：group K1：CSCI of 0.5 μg·kg-1·min-1 ketamine;group K2：CSCI 1 μg·kg-1·min-1 ketamine;group K3：CSCI 2 μg·kg-1·min-1 ketamine;group C：CSCI of saline.Sufentanil usage,VAS score and the adverse events 8,24 and 48 h after surgery were recorded.Results Compared with group C,VAS scores were significantly lower in the other three groups 8,24 and 48 h after operation,especially for group K3（P〈0.05 or P〈0.01）.Ketamine dose dependently reduced sulfentanil dosage.There was no significant difference in postoperative nausea and vomiting among the four groups.The incidence of drowsiness in group K3 were significantly higher than that of the other three groups 8,24 and 48 h after operation（P〈0.05）.Eight patients had diplopia and 2 patients had hallucinations in group K3.Conclusion Continuous subcutaneous infusion of ketamine 1 μg·kg-1·min-1 can improve the analgesic effect of subcutaneous sufentanil without increasing side effects.
出处
《临床麻醉学杂志》
CAS
CSCD
北大核心
2012年第4期349-351,共3页
Journal of Clinical Anesthesiology
关键词
氯胺酮
舒芬太尼
患者自控皮下镇痛
Ketamine； Sufentanil； Patient-controlled subcutaneous analgesia
