| 不同剂量氯胺酮超前镇痛对小儿腺样体消融术后疼痛的影响 |
| 投稿时间：2017-04-05 修订日期：2017-04-17 点此下载全文 |
| 引用本文：黄佳佳,金立红,黄悦.不同剂量氯胺酮超前镇痛对小儿腺样体消融术后疼痛的影响[J].医学研究杂志,2017,46(12):129-131 |
| DOI：
10.11969/j.issn.1673-548X.2017.12.032 |
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| 中文摘要:目的 探讨不同剂量氯胺酮超前镇痛对小儿腺样体消融术后疼痛的影响。方法 选取腺样体消融伴或不伴扁桃体摘除术患儿90例，ASA分级Ⅰ级，年龄2~9岁，体重13~36kg，采用随机数字表法将其分为3组，分别在麻醉诱导后静脉给予生理盐水（对照组），氯胺酮0.2mg/kg （K1组）和0.5mg/kg （K2组）。记录患儿苏醒期（0、15、30min、2、6、12h） FLACC评分，若FLACC>4分，给予曲马多和双氯芬酸钾肛栓补救镇痛。记录3组患儿手术持续时间、麻醉持续时间、拔管时间、苏醒时间、术后恶心呕吐、头痛及腹痛的发生情况。结果 与对照组比较，K1和K2组在苏醒早期（0~30min） FLACC评分显著降低，补救药使用率显著减少（P<0.05）。与K1组比较，K2组苏醒期FLACC评分差异无统计学意义（P>0.05），但苏醒时间延长（P<0.05）。3组在2h后FLACC评分、手术及麻醉持续时间、拔管时间，术后恶心、呕吐、腹痛及头痛发生率上差异无统计学意义（P>0.05）。结论 术前静脉给予0.2mg/kg和0.5mg/kg氯胺酮均能显著减少小儿腺样体消融术后早期疼痛，但0.5mg/kg组可能导致苏醒时间延长，0.2mg/kg可能是一个更合适的剂量。 |
| 中文关键词:氯胺酮 超前镇痛 腺样体消融术 |
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| Preemptive Analgesic Effect of Two Doses of Ketamine for Postoperative Pain Relief in Children Following Adenotonsillectomy |
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| Abstract:Objective To investigate the efficacy of two low doses of ketamine for postoperative pain relief in children following adenotonsillectomy.Methods Ninety ASA physical status Ⅰ patients, aged 2-9 years, scheduled for adenotonsillectomy were enrolled in this randomized, double-blinded study. Patients were divided into three groups of 30 each and received an intravenous injection of 0.9% saline (group C), ketamine 0.2mg/kg (group K1), or ketamine 0.5mg/kg (group K2). FLACC scores were used to evaluate pain levels during 12h after surgery. Tramadol and diclofenac potassium suppositories were provided for pain relief if FLACC>4. The operating time(OT), anesthesia duration(AT), extubation time(ET)and awaking time(AWT) were recorded. Adverse reactions such as nausea, vomiting, headache,abdominal pain and the requirement of rescue analgesic was recorded.Results Group C had significant higher FLACC scores than group K1 and K2 during the first 30min after operation. The requirement of analgesics was also higher in the control group(P<0.05). No significant difference of FLACC scores was found between group K1 and K2. However, children in K2 group have longer awaking time (P<0.05). There was no significant difference among three groups in the FLACC score after 2 hours.Conclusion A 0.2 or 0.5mg/kg dose of ketamine given before surgery by intravenous injection provides efficient pain relief in the early period after surgery. 0.2mg/kg may be preferable for its low incidence of deep sedation. |
| keywords:Ketamine Preemptive analgesia Adenotonsillectomy |
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