【摘要】 目的比较不同剂量氯胺酮与0.25%罗哌卡因合用于下腹部手术患者术后镇痛的有效性和安全性,以便确定一个合适的临床使用剂量。方法120例ASAⅠ~Ⅱ级硬膜外麻醉下接受下腹部手术患者随机分为4组,各组患者术中麻醉以2%利多卡因硬膜外阻滞维持,縫皮时,A组硬膜外注入0.25%罗哌卡因10ml,B、C、D组注入0.25%罗哌卡因10ml分别内含氯胺酮0.25、0.5、0.75mg/kg。观察各组术后VAS评分,术毕至第1次用阿片类药物的时间,镇静评分、评分、运动阻滞评分,尿潴留情况,术后恶心呕吐情况,精神症状出现情况,心率、血压、呼吸及脉氧饱和度变化情况,以评估氯胺酮用于硬膜外术后镇痛的作用并探索氯胺酮用于硬膜外术后镇痛的合适剂量。结果C组和D组首次镇痛时间明显长于其他2组,C组和D组需要哌替啶补充镇痛者明显少于其他2组,C组和D组之间镇痛效果比较差异无统计学意义,D组不良反应与其他各组比较虽差异无统计学意义,但有增加趋势。结论小剂量氯胺酮复合0.25%罗哌卡因单次硬膜外注射用于下腹部手术患者术后镇痛可取得较好效果,其合适剂量为0.5mg/kg。更多还原

【Abstract】 Objective To identify the optimal dose of ketamine that produces the maximum duration of postoperative epidural analgesia with minimal adverse effects as an adjuvant to 0.25% ropivacaine for epidural block.Methods One hundred and twenty adult patients,ASAⅠ-Ⅱ,aged 18 to 50 years,undergoing lower abdominal surgery were allocated randomly to receive A of D solutions for epidural analgesia at the beginning of skin suture.Group A received 10ml of 0.25% ropivacaine.Grooup B received 10ml of 0.25% ropivacaine with ketamine 0.25mg/kg.Group C received 10ml of 0.25% ropivacaine with ketamine 0.5mg/kg and group D received 10ml of 0.25% ropivacaine with ketamine 0.75mg/kg.The anesthesia for each patient during the operation was maintained with epidural 2%lidocaine.Postoperative pain was assessed using the visual analog scale(VAS) scores.Patients were given pethidine 1mg/kg intramuscularly as a supplemental analgesic when this score exceeded D.Results The mean time for the first requirement of analgesia was 3.5h in group A and 8.2h in group B compared with 22.8h in group C(P<0.05) and 23.6h in group D(P<0.05).Supplemental analgesia requirements with pethidine were significantly less in group C(3 subjects) and group D(1 subject) when compared with group A(30 subjects) and group B (22 subjects).There were no differences between the four groups in the incidence of motor blockade,emesis,or sedation.Although there were no statistical differences between the four groups,group 4 had a little higher incidence of side effects such as hallucination or sleepiness than the other groups.Conclusion The optimal dose of ketamine is 0.5mg/kg added to 10ml of 0.25% ropivacaine for postoperative epidural analgesia in lower abdominal surgery without an increase in side effects.更多还原