【摘要】 目的观察预注小剂量氯胺酮或帕瑞昔布对瑞芬太尼麻醉后痛觉过敏的影响。方法全身麻醉下行开腹子宫切除术患者60例,随机均分为氯胺酮组(K组):麻醉前10 min静脉注射氯胺酮0.5 mg/kg;帕瑞昔布组(P组):帕瑞昔布0.5 mg/kg;对照组(N组):麻醉前10 min静脉注射生理盐水5 ml。三组均3μg/L靶控输注瑞芬太尼,靶控输注丙泊酚(血浆靶浓度4 mg/L)行麻醉诱导和维持。术后行静脉自控镇痛(PCIA)。术后2 h内如果VAS评分≥4分,静脉给予吗啡1~2mg。记录VAS评分≥4分时间(从麻醉停药后第一次VAS评分≥4分的时间),第一次≥4分的VAS评分,静脉注射吗啡后VAS评分<4分所需时间,PACU和PCIA中吗啡用量、术后30、45、60、90、120 minVAS评分。结果与N组比较,K组和P组术后VAS评分≥4分时间延长,PACU中吗啡总用量减少,术后30、45、60、90、120 min的VAS评分降低(P<0.05);K组和P组各指标差异无统计学意义。结论预先注射氯胺酮或帕瑞昔布均可缓解瑞芬太尼麻醉后痛觉过敏。更多还原

【Abstract】 Objective To investigate the effects of pretreatment with ketamine or parecoxib on postoperative analgesia after remifentanil anesthesia.Methods Sixty general anesthesia patients(ASA ⅠorⅡ) undergoing elective open hysterectomy were randomly divided into 3 groups.All patients received normal saline 5 ml(group N),ketamine 0.5 mg/kg(group K) or parecoxib 0.5 mg/kg(group P) 10 min before anesthesia.Anesthesia was induced and maintained with IV infusion of remifentail at a target plasma concentration of 3 μg/L and propofol at a target plasma concentration of 4 mg/L.All the patients received PCIA with morphine after operation.Additional 1-2 mg morphine was given when the patients’ VAS was greater or more than 4.The time when VAS ≥4 happened at the first time,number of VAS score,the time when VAS <4 after morphine treatment,and morphine consumption during the first 2 h after surgery.VAS scores and morphine consumption 30,45,60,90 and 120 min after operation were also recorded.Results Compare with group NS,the time when VAS ≥4 happened at the first time was prolonged and the scores were lower in group K and group P(P <0.05).Morphine consumption was decreased and VAS scores were lower 30,45,60,90,and 120 min after surgery in group K and group P without any difference between them.Conclusion Pretreatment with either ketamine or parecoxib is effective to relieve postoperative hyperalgesia after intravenous anesthesia with propofol and remifentanil.更多还原