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小剂量氯胺酮对人工流产术后恢复的影响
The impact of low-dose ketamine on postoperative analgesia and side-effects in abortion

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DOI:
作者:
段怡，黄小静，汪正平，张俊杰，李士通
DUAN Yi, HUANG Xiaojing, WANG Zhengping, ZHANG Jun
作者单位:
上海交通大学附属第一人民医院疼痛科（段怡、黄小静、汪正平），麻醉科（张俊杰、李士通）
Department of Painmanagement, Shanghai First People's Hospital, Shanghai Jiaotong University（DUAN Yi, HUANG Xiaojing, WANG Zhengping），Department of Anesthesiology（ZHANG Junjie, LI Shitong）
关键词:
无痛人流；小剂量氯胺酮；术后镇痛；PONV
Analgesic abortion; low-dose ketamine; postoperative analgesia; PONV
摘要:
目的 观察小剂量氯胺酮能否缓解人流术后的疼痛及是否会增加术后副反应的发生率。 方法 400例拟行无痛人流术的患者，采取随机双盲法，分成四组，每组100例。F1组：芬太尼1μg/kg；F2组：芬太尼1.5μg/kg；FK1组：芬太尼1μg/kg+氯胺酮0.1mg/kg；FK2组：芬太尼1μg/kg+氯胺酮0.2mg/kg，随后均予以丙泊酚1.5mg/kg，术中有体动时追加丙泊酚20mg。记录四组患者术中丙泊酚总用量，清醒即刻和术后6小时疼痛数字分级评分（NRS，0-10分），及术毕6小时内恶心、呕吐等副反应发生率。 结果 四组患者一般资料无统计学差异（P>0.05）。四组术中丙泊酚的总用量分别为F1组（135.10±29.08）mg，F2组（107.90±63.44）mg，FK1组（94.45±14.16）mg，FK2组（90.05±16.73）mg，组间两两比较有统计学差异（P<0.01）。清醒即刻四组患者NRS疼痛评分无统计学差异（P>0.05），但在术后6小时随访中完全无痛患者例数，F1组为73.2%（71/97），显著低于其余3组（P<0.05）。FK1、FK2组术后恶心呕吐发生率及呕吐发生率高于F1组（P<0.05）。 结论 无痛人流麻醉诱导时辅以小剂量氯胺酮能显著缓解术后疼痛，但因术中丙泊酚用量相应减少，有增加术后恶心、呕吐风险，应注意预防。
Objective To investigate whether low-dose ketamine can relieve postoperative pain from abortion and increase the incidence of postoperative side-effects. Methods In a randomized, double-blind, prospective study, 400 patients scheduled for analgesic abortion were randomly assigned to four groups to receive intravenous administration of fentanyl 1μg/kg (Group F1, n=100), fentanyl 1.5 μg/kg (Group F2, n=100), fentanyl 1μg/kg + ketamine 0.1mg/kg (Group FK1, n=100) or fentanyl 1μg/kg + ketamine 0.2mg/kg (Group FK2, n=100), all followed by propofol 1.5 mg/kg. During surgery, propofol was supplemented 20mg each time to prevent patients from movement. Total propofol consumptions, a 0-10 numerical rating scale (NRS) at the moment of recovery from anesthesia and 6h, all episodes of nausea or vomiting for postoperative 6 hours were recorded in all patients by an investigator who was blinded to treatment assignments. Results The baseline parameters were statistically insignificant (P>0.05) in the four groups. The total propofol consumptions of four groups are Group F1 (135.10±29.08) mg, Group F2 (107.90±63.44) mg, Group FK1 (94.45±14.16) mg, Group FK2 (90.05±16.73) mg respectively, with multiple comparisons of significant difference (P<0.01). NRS is statistically insignificant (P>0.05) at the moment of recovery from anesthesia but the percentage of NRS 0 is significantly lower in Group F1 compared to other three groups. In Group FK1 and FK2, patients showed a significantly higher incidence of PONV and vomiting compared to patients of Group F1 (p<0.05). Conclusion Addition of low-dose ketamine to propofol-fentanyl anesthesia can significantly relieve postoperative pain but with higher risk of PONV owing to the decreasing of propofol consumption in analgesic abortion.

 

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