氯胺酮对术中应用芬太尼导致的术后吗啡需求增加的抑制作用

中国临床药理学与治疗学 ›› 2009, Vol. 14 ›› Issue (5): 577-581.

氯胺酮对术中应用芬太尼导致的术后吗啡需求增加的抑制作用

虞雪融, 黄宇光, 王海兰, 居霞

北京协和医院麻醉科, 北京100730

收稿日期:2009-02-02 修回日期:2009-04-17 发布日期:2020-11-09
通讯作者: 黄宇光, 男, 教授, 博士生导师, 研究方向:疼痛的临床与基础研究。Tel:010-65295580 E-mail:pumchhyg @yahoo.com. cn
作者简介:虞雪融, 女, 医学博士, 研究方向:疼痛的临床与基础研究。Tel:010-65294278 E-mail:yxr313 @yahoo. com.cn

Effects of ketamine on preventing the increase of postoperative morphine requirement induced by fentanyl

YU Xue-rong, HUANG Yu-guang, WANG Hai-lan, JU Xia

Department of Anesthesiology, Peking Union Medical College Hospital, Beijing 100730, China

Received:2009-02-02 Revised:2009-04-17 Published:2020-11-09

摘要/Abstract

摘要： 目的:旨在观察氯胺酮对术中应用芬太尼导致的术后吗啡需求增加的影响。方法:采用双盲方法将60 例拟在腰麻下行开腹子宫切除术的患者随机分为4 组:对照组(生理盐水, C)、芬太尼组(单次给予芬太尼1 μg/kg, 共3 次, 间隔15 min,F)、氯胺酮组(切皮至手术结束前20 min连续输注氯胺酮15 μg·kg^-1 ·min^-1, K)、氯胺酮及芬太尼组(切皮至手术结束前连续输注氯胺酮15 μg·kg^-1 ·min^-1; 术中单次给予芬太尼1 μg/kg,共3 次, 间隔15 min, FK) 。于术后1、 3、 6、 12、 24及48 h 记录累计吗啡需要量、痛觉评分及药物副作用(恶心、呕吐、幻觉、头晕、头痛及皮肤瘙痒) 。结果:共60 例患者入选本研究。4 组患者的年龄、体重、手术持续时间及术后感觉阻滞时间差异无统计学意义。F 组术后3、 6、 12 h 的累计吗啡需要量显著高于C 组(P <0. 05) 。C 组、K 组及FK组患者在术后各时间点的累计吗啡需要量差异无统计学意义。各组患者的术后痛觉评分差异无统计学意义。K 组及FK 组患者的术中及或术后幻觉发生率显著高于C 组(P <0. 05) 。结论:本研究结果显示术中使用芬太尼可导致患者术后吗啡消耗量增加, 而预先使用N-甲基-D-天门冬氨酸(NMDA) 受体拮抗剂氯胺酮可预防芬太尼的以上作用。

关键词: 急性阿片耐受, 痛觉过敏, 术后疼痛, 氯胺酮

Abstract: AIM:To observe the effects of ketamine on preventing the increase of postoperative morphine requirement induced by fentanyl.METHODS: Sixty women undergoing total abdominal hysterectomy by spinal anaesthesia were assigned to 4 groups consisting of placebo (normal saline, C), fentanyl (3 bolus of 1 μg/kg, at 15 min intervals, F), ketamine (infusion of 15 μg·kg^-1 ·min^-1 ketamine from the skin incision until 20 min before the end of the surgery, K), ketamine and fentanyl (infusion of 15 μg·kg^-1·min^-1 ketamine from the skin incision until 20 min before the end of the surgery plus 3 bolus of 1 μg/kg fentanyl, at 15-min intervals, FK). The cumulative morphine consumption, pain score, and adverse effects (nausea, vomiting, hallucination, dizziness and itching) were recorded at 1, 3, 6, 12, 24, 48 h postoperatively. RESULTS:There were no significant differences in age, weight, duration of surgery and the post-operative sensory block time. The cumulative morphine consumption in group F was significantly higher than those in group C at 3, 6, 12 h postoperatively (P <0. 05). The postoperative cumulative morphine consumption was similar in group C, K and FK. No differences in posterative pain score were observed among the group. More patients in K and FK group had hallucination during and or after the surgery than those in group C (P <0. 05). CONCLUSION: These results suggested that intraoperative administration of fentanyl increased postoperative morphine consumption, which could be prevented by coadministration of ketamine.

Key words: acute opioid tolerance, hyperalgesia, postoperative pain, ketamine

中图分类号:

R614

虞雪融, 黄宇光, 王海兰, 居霞. 氯胺酮对术中应用芬太尼导致的术后吗啡需求增加的抑制作用[J]. 中国临床药理学与治疗学, 2009, 14(5): 577-581.

YU Xue-rong, HUANG Yu-guang, WANG Hai-lan, JU Xia. Effects of ketamine on preventing the increase of postoperative morphine requirement induced by fentanyl[J]. Chinese Journal of Clinical Pharmacology and Therapeutics, 2009, 14(5): 577-581.

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