[1]吕海港,李 潞,赵 欣,等.术中亚麻醉剂量氯胺酮在发育性髋关节脱位截骨矫形术超前镇痛中的应用[J].陕西医学杂志,2021,50(2):166-169.[doi:DOI:10.3969/j.issn.1000-7377.2021.02.010]
　LYU Haigang,LI Lu,ZHAO Xin,et al.Preemptive analgesia effect of intraoperative sub-anaesthetic dose of ketamine on developmental dislocation of the hip with Salter innominate osteotomy[J].,2021,50(2):166-169.[doi:DOI:10.3969/j.issn.1000-7377.2021.02.010]
点击复制

术中亚麻醉剂量氯胺酮在发育性髋关节脱位截骨矫形术超前镇痛中的应用
分享到：

《陕西医学杂志》[ISSN:1000-7377/CN:61-1281/TN]

卷:
50
期数:
2021年2期
页码:
166-169
栏目:
临床研究
出版日期:
2021-02-05

文章信息/Info

Title:
Preemptive analgesia effect of intraoperative sub-anaesthetic dose of ketamine on developmental dislocation of the hip with Salter innominate osteotomy
作者:
吕海港1; 李 潞1; 赵 欣1; 王 仿1 ; 郑仔钰2;  邓国华1
(1.西安交通大学附属红会医院,陕西 西安 710054; 2.长安大学地质工程与测绘学院,陕西 西安710054)
Author(s):
LYU Haigang; LI Lu; ZHAO Xin; WANG Fang; ZHENG Ziyu; DENG Guohua
(Honghui Hospital,Xi'an Jiaotong University,Xi'an 710054,China)
关键词:
亚麻醉剂量;  氯胺酮;  截骨术;  小儿;  镇痛
Keywords:
Sub-anesthetic dose;  Ketamine;  Osteotomy;  Children;  Analgesia
分类号:
R 614.2
DOI:
DOI:10.3969/j.issn.1000-7377.2021.02.010
文献标志码:
A
摘要:
目的:评价术中应用亚麻醉剂量氯胺酮对发育性髋关节脱位Salter骨盆截骨矫形手术患儿的超前镇痛效果。方法:选择发育性髋关节脱位拟行Salter骨盆截骨矫形术患儿60例,年龄3～5岁,随机分为两组,氯胺酮超前镇痛麻醉手术组(K组),常规麻醉手术对照组(C组)。K组在全身麻醉后静脉持续微量泵输注亚麻醉剂量氯胺酮0.3 mg/(kg·h)至手术结束; C组常规进行静吸复合全身麻醉。评估术后即刻,2、4、8、12、24 h患儿的FPS-R评分及Ramsay镇静评分,观察相关不良反应的发生情况及追加镇痛的次数。结果:与C组比较,K组在术后即刻,2、4、8 h的FPS-R评分明显降低,差异均有统计学意义(均P<0.05),而在12、24 h均无统计学差异(均P>0.05); K组在术后即刻,2、4 h的Ramsay镇静评分明显优于C组(均P<0.05); 而术后恶心、呕吐、皮肤瘙痒、嗜睡的发生率两组比较均无统计学差异(均P>0.05)。结论:术中持续输注亚麻醉剂量氯胺酮能显著减轻先天性髋关节脱位Salter骨盆截骨矫形手术患儿术后疼痛,起到超前镇痛作用,且不增加术后不良反应的发生率。
Abstract:
Objective:To evaluate the preemptive analgesic effect of intraoperative sub-anaesthetic dose of ketamine on developmental dislocation of the hip in children with Salter innominate osteotomy.Methods:Sixty children aged 3-5 years with the developmental dislocation of the hip were selected and scheduled for elective Salter innominate osteotomy.They were randomly divided into preemptive analgesia anesthesia with ketamine group(group K)and routine anesthesia operation control group(group C).The group K received intravenous infusion of ketamine 0.3 mg/kg until the end of operation.The group C received general anesthesia.The FPS-R score and Ramsay sedation score were recorded at 0,2,4,8,12 and 24 hours after surgery.The incidence of related adverse reactions and the times of additional analgesia were observed and recorded.Results:Compared with group C,the FPS-R score of group K decreased significantly at 0,2,4,and 8 hours after surgery(all P<0.05),but there was no statistical difference at 12 and 24 hours(all P>0.05).The Ramsay sedation score of group K at 0,2 and 4 hours after surgery were significantly better than those of group C(all P<0.05).However,t here was no statistical difference in the incidence of postoperative nausea,vomiting,skin itching,and lethargy between the two groups(all P>0.05).Conclusion:Continuous infusion of ketamine at sub-anesthetic dose during operation can significantly reduce postoperative pain in children with the developmental dislocation of the hip after Salter innominate osteotomy,which play a preemptive analgesic effect,and does not increase the incidence of postoperative adverse reactions.

参考文献/References:

[1] 江 君,任 爽,刘 敏.Salter骨盆截骨术对发育性髋关节脱位髋臼影响的研究[J].中国修复重建外科杂志,2015,43(11):1332-1336.
[2] Ji YL,Youn YJ.Attention to postoperative pain control in children[J].Korean Journal of Anesthesiology,2014,66(3):183-188.
[3] Jennings PA,Cameron P,Bernard S,et al.Morphine and ketamine is superior to morphine alone for out-of-hospital trauma analgesia:A randomized controlled trial[J].Ann Emerg Med,2012,59(6):497-503.
[4] 姚 函,任宪凤,尹毅青.小剂量氯胺酮临床应用的研究进展[J].中日友好医院学报,2018,24(3):180-182.
[5] 齐佩君,汪文良.小剂量氯胺酮超前镇痛在剖宫产手术中的应用价值[J].中国药物经济学,2019,21(11):79-81.
[6] Kator S,Correll DJ,Judy Y,et al.Assessment of low-dose i.v.ketamine infusions for adjunctive analgesia[J].American Journal of Health System Pharmacy,2016,73(1):22-29.
[7] Sawynok J.Topical and peripheral ketamine as an analgesic[J].Anesthesia and Analgesia,2014,119(1):170-178.
[8] 韩佩荣.儿童动态心电图不同时段参数与心率变异性相关性研究[J].陕西医学杂志,2018,47(9):1143-1146.
[9] 李玲霞,白 玲,李元霞,等.学龄期儿童全身麻醉机械通气潮气量大小研究进展[J].陕西医学杂志,2020,49(3):378-380.
[10] Graudins A,Meek R,Egerton WD,et al.The PICHFORK(pain in children fentanyl or ketamine)trial:A randomized controlled trial comparing intranasal ketamine and fentanyl for the relief of moderate to severe pain in children with limb injuries[J].Ann Emerg Med,2015,65(3):248-254.
[11] 陈丽丽,夏中元.亚麻醉剂量氯胺酮预防术后疼痛的临床应用及进展[J].医学综述,2019,21(10):4301-4305.
[12] 陶文辉,丁盼盼,涂茂勇,等.亚临床剂量氯胺酮在小儿麻醉中对七氟烷MAC和拔管EC-(50)的影响[J].广东医学,2020,34(17):1811-1813,1817.
[13] 杨云丽,麻伟青,张承华,等.小剂量氯胺酮对骨盆截骨术患儿术后镇痛的影响[J].临床麻醉学杂志,2014,32(4):380-382.
[14] Suzuki M,Haraguti S,Sugimoto K,et al.Low-dose intravenous ketamine potentiates epidural analgesia after thoracotomy[J].Anesthesiology,2006,105(1):111-119.
[15] Taylor M,Jakacki R,May C,et al.Ketamine PCA for treatment of end-of-life neuropathic pain in pediatrics[J].Am J Hosp Palliat Care,2015,32(8):841-848.

备注/Memo

备注/Memo:
基金项目:陕西省临床医学研究中心项目(2020LCZX-03)
更新日期/Last Update: 2021-01-28