《中国康复理论与实践》

《中国康复理论与实践》 ›› 2007, Vol. 13 ›› Issue (01): 86-88.

• 临床研究 • 上一篇    下一篇

小剂量氯胺酮联合吗啡用于颈段脊髓损伤患者术后静脉镇痛的研究

王强1; 王增春1; 王保国2   

  1. 1.北京博爱医院麻醉科,北京市 100068;2.首都医科大学附属北京天坛医院麻醉科,北京市 100050
  • 收稿日期:2005-12-26 出版日期:2007-01-01 发布日期:2007-01-01

Continuous Intravenous Infusion of Low Dose of Ketamine Combined with Morphine Used For Postoperative Analgesia in Patients with Cervical Spinal Cord Injury

WANG Qiang, WANG Zeng-chun, WANG Bao-guo   

  1. Department of Anesthesiology, BeijingCharity Hospital, Beijing 100068, China
  • Received:2005-12-26 Published:2007-01-01 Online:2007-01-01

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摘要： 目的比较小剂量氯胺酮联合吗啡在颈段脊髓损伤患者术后静脉镇痛中的临床效应及副作用的发生率,并探讨氯胺酮的合适剂量。方法将87例在静吸复合全麻下接受颈后路椎管减压术的颈髓损伤患者随机分成3组:M组接受吗啡0.02mg/kg·h,MK1组接受吗啡0.02mg/kg·h+氯胺酮0.02mg/kg·h,MK2组接受吗啡0.02mg/kg·h+氯胺酮0.04mg/kg·h静脉术后镇痛治疗。分别于手术结束后2h、4h、8h、12h、24h、48h记录疼痛、镇静评分、发生的不良反应(瘙痒、恶心呕吐、精神症状)、血氧饱和度。结果MK2组的疼痛评分在各时间点均明显低于M组和MK1组在相同时间点的疼痛评分(P<0.01),而M组和MK1组之间无显著性差异(P>0.05)。3组之间的镇静评分无显著性差异(P>0.05)。M组中恶心、呕吐(18.5%)以及皮肤瘙痒(7.4%)的发生率较高,但是3组之间无显著性差异(P>0.05)。3组中均未出现具有精神症状的病例。3组的血氧饱和度值在各时间点均不低于96%,而且3组之间无显著性差异(P>0.05)。结论0.04mg/kg·h氯胺酮在颈髓损伤患者静脉术后镇痛中能够增强吗啡(0.02mg/kg·h)的镇痛作用,而且不增加副作用。

关键词: 氯胺酮, 吗啡, 术后镇痛, 脊髓损伤, 颈

Abstract: ObjectiveTo evaluate the effect and the side-effect of continuous intravenous infusion of low dose of ketamine combined with morphine for postoperative analgesia in patients with cervical spinal cord injury, and determine the suitable dosage of ketamine. Methods87 patients with cervical spinal cord injury scheduled for the cervical vertebra operation via posterior routine under intravenous and inhalation combined anesthesia were randomly allocated into three groups, i.e. Group M (morphine 0.02 mg/kg·h), Group MK1 (morphine 0.02 mg/kg·h + ketamine 0.02 mg/kg·h), and Group MK2 (morphine 0.02 mg/kg·h + ketamine 0.04 mg/kg·h), to accept intravenous postoperative analgesia. The pain scores of VAS, sedation scores, the incidence of side-effect including itching, nausea, vomiting, and central excitatory phenomena, and SpO2 were recorded at 2 h, 4 h, 8 h, 12 h, 24 h and 48 h after operation. ResultsThe pain score of group MK2 at each time point was significantly lower than that of group M or group MK1 (P<0.01), and there was no significant difference between group M and group MK1 (P>0.05). There was not significant difference among the three groups (P>0.05) on sedation scores. No significant difference was found in the incidence of nausea, vomiting, or itching among these groups (P>0.05), although the nausea and vomiting (18.5%) and itching (7.4%) were a little higher in Group M. No case with central excitatory phenomena was found in each group. At each time point, no significant difference was found in SpO2 among these groups groups (P>0.05), and all the SpO2 values were not less than 96%. Conclusion0.04 mg/kg·h of ketamine can enhance the efficacy of morphine (0.02 mg/kg·h) and do not increase side-effect events.

Key words: ketamine, morphine, postoperative analgesia, spinal cord injury, cervix