摘要
将75例连续硬膜外麻醉的手术后患者，留置硬膜外导管，随机分为A，B和C三组。在患者麻醉作用消失，诉说疼痛开始时，评价疼痛程度（VRS-5）。用盲法分别自留置的硬膜外导管注入（A）氯胺酮25mg＋0．75％布比卡因2ml＋生理盐水至10ml，（B）氯胺酮25mg＋生理盐水至10ml和（C）0．75％布比卡因2ml＋生理盐水至10ml。注药后记录镇痛起效时间和维持时间，评价镇痛效果（VRS-5），监测患者BP、HR、RR、SaO2等变化0～120分钟。结果表明：A、B、C组起效时间分别为3．0±2．0、3．0±2．0和4．5±2．8分钟，无明显差异（P＞0．05）。A组镇痛效果明显强于B（P＜0．01）、C（P＜0．05）组（依注药前后疼痛等级的变化比较），镇痛维持时间A（368±54min）＞C（246±41min）＞B（92±24min）。除A组6例，B组4例注药后轻度嗜睡（与氯胺酮作用有关）外，所有患者无其他副作用。我们认为：小剂量氯胺酮与低浓度布比卡因复合液硬膜外术后镇痛，起效快，作用时间长，镇痛效果可靠，副作用少，是一种良好的术后镇痛方法。
75 patients underwent surgical operations under epidural anesthesia were administered drug via the epidural catheter when they reported post-operative pain after the disap pearance of the anesthetic effect. The patients were randomly distributed into 3 groups and administered with 3 different solutions in a blind manner. Solution A: ketamine 25mg+ bupivacaine 0. 75% (2ml) and made up to 10 ml by normal saline. Solution B: Ketamine 25 mg in 10 ml normal saline. Solution C: bupivacaine 0. 75% 2 ml, in 10 ml normal saline. The patients were asked to score their intensity of pain by VRS-5 in 5 degree scale before epidural injection, and report the staring time of analgesia as well as the duration of analgeisa, and score the degree of pain when maximal analgesia was achieved. In the mean time, BP, HR, RR and SaO2 were monitored for a total of 120 min. The results indicate that (1) there was no difference among the 3 groups in the starting time of analgesic effect (3.0±2.0, 3. 0±2. 0, 4. 5±2. 8 min in group A,B and C respectively, x±s). The po tency of analgesia was sighficanily higher in group A as compared to group B (P<0.01) and group C (P<0.05). The duration of analgesia was A (362±54min)>C(246± 41min)>B (92±34min). No significant side effects were revealed except for slight somnolence in 6 cases in group A and 4 cases in group B, presumably induced by ketamine.It is concluded that low dose ketamine in combination with low dose bupivacaine for epidural administration is a good method for post-operative analgesia because of its rapid, prolonged and reliable analgesia and slight side effect.
出处
《中国疼痛医学杂志》
CAS
CSCD
1997年第2期88-90,共3页
Chinese Journal of Pain Medicine
