摘要
目的评价小剂量氯胺酮联合吗啡静脉患者自控镇痛（PCA）对开胸食管癌根治术后镇痛的效果及对血浆β-内啡肽（EP）浓度的影响。方法30例ASAⅠ-Ⅱ级，年龄35—65岁，体重42～75kg，择期开胸食管癌根治术后的患者，随机分为2组（n=15），全麻清醒后，当患者VAS评分≥3分时静脉注射负荷量吗啡2～3mg，同时开始静脉患者自控镇痛，m组采用吗啡0．02mg·kg^-1·h^-1（按50h计算），mk组采用吗啡0．02mg·kg^-1·h^-1＋氯胺酮0．08mg·kg^-1·h^-1，治疗过程中若VAS评分≥3分时追加吗啡2～3mg行补救镇痛。分别于术后4、8、20、24、48h记录疼痛强度（VAS评分法），术后吗啡用量，病人自控镇痛（PCA）的实际按压次数及有效按压次数，药物不良反应（恶心、呕吐、皮肤瘙痒、做梦、幻觉）发生率及生命体征[脉搏血氧饱和度（SpO2），呼吸频率（RR），心率（HR）及平均动脉压（MAP）]，并于入室时（T0），术毕（T1），术后6h（T2），24h（T3），48h（T4），采取中心静脉血检测血浆β-EP浓度。结果术后4～48h之内，活动状态下VAS评分mk组低于m组（P〈0．05）；静息状态下两组VAS评分相近（P〉0．05），吗啡总用量mk组低于m组（P〈0．05）；PCA按压次数mk组低于m组（P〈0．05）。术后恶心、呕吐、皮肤瘙痒发生率mk组低于m组（P〈0．05），做梦、幻觉发生率两组尤差异。生命体征均平稳；血浆β-Ep浓度变化两组存在差异。结论小剂屠氯胺酮（0．08mg·kg^-1·h^-1）联合吗啡（0．02mg·kg^-1·h^-1）静脉自控镇痛对开胸食管癌根治术后镇痛效果好，副作用发牛率低，对血浆β-EP浓度影响小。
Objective To evaluate the effects of patient-controlled analgesia （PCA） with small dose ketamine combined with morphine on analgesia and influence thereof on the plasma β-endorphin （EP） level in the patients after radical operation for esophageal carcinoma. Methods Thirty ASA Ⅰ-Ⅱ patients, aged 35 -65, weighing 42 -75 kg, with visual analogue score ≥3, undergoing elective radical operation for esophageal carcinoma under general anesthesia received intravenous morphine 2 - 3 mg were randomly divided into 2 equal groups： group m receiving morphine 0.02 mg·kg^-1·h^-1 , and with group mk receiving morphine 0.02 mg·kg^-1·h^-1 combined with ketamine 0.08 mg·kg^-1·h^-1 for 50 h. In the course of treatment the patients received intravenous injection of morphine 2 -3 mg when the VAS was ≥3. VAS was recorded 4, 8, 20, 24, and 48 h after operation. The amount of morphine used after operation, PCA button pressing times （effective/active）, side effects, and vital signs including pulse, saturation of blood oxygen, respiratory rate, heart rate, and average arterial pressure were recorded. Central venous blood samples were collected when entering the operation room （ T0 ）, by the end of operation （ T1 ） , and 6 h （ T2 ）, 24 h （ T3 ）, and 48 h （ T4 ） after operation respectively to examine the β-endorphin level. Results During the period 4 -48 h after operation the VAS scores of the group mk were significantly lower than those of the group m in activity state （ all P 〈 0.05 ） and were not significantly different those of the group m at resting state （ all P 〉 0.05 ）. The total amount of morphine consumed and the actual PCA button pressing times were significantly less in the group mk than in the group m （ both P 〈 0.05）. The incidence rates of nausea, vomiting, and pruritus of the group mk were all significantly lower than those of the group m （all P 〈 0.05）. There were not significant differences in the incidence rates of dreaming and pseudoesthesia between these 2 groups. All the vital signs were stable in the 2 groups. The plasma β-EP levels at the time point T1 of these 2 groups were both significantly higher than those at To （ both P 〈 0.05 ）. The plasma β- endorphin levels at T2.4 of the group mk decreased gradually from the level at T1 to the level at To, and the plasma β-endorphin levels of the group m rapidly decreased from the level at To to the To level and remained at this level to the 48 h after operation. Conclusion The combination of small dose of ketamine with morphine provides optimal analgesia with low side-effect rate and little effect on the plasma β-EP level.
出处
《中华医学杂志》
CAS
CSCD
北大核心
2009年第5期314-317,共4页
National Medical Journal of China
