加巴喷丁和氯胺酮用于子宫切除术后多模式镇痛效果比较

摘要

目的：比较加巴喷丁和氯胺酮用于子宫切除术后急、慢性疼痛的镇痛效果。方法选择行经腹子宫切除术患者60例，随机分为氯胺酮组（K 组）和加巴喷丁组（G组），各30例。K 组患者术前2 h口服安慰剂维生素 C 片50 mg，麻醉诱导前给予负荷量氯胺酮(0.5 mg∕kg )，术中持续泵注0.25 mg∕（kg·h）；G组患者术前2 h口服加巴喷丁600 mg，手术开始前和术中分别给予与氯胺酮等体积的0.9％氯化钠注射液作为负荷量和持续泵注量。两组患者均给予瑞芬太尼、丙泊酚、顺阿曲库铵麻醉诱导和维持，以实现超前镇痛。观察并比较两组患者的镇痛效果。结果入麻醉后监测治疗室（PACU）及术后0.5，2，4，24 h，G组疼痛视觉模拟评分法（VAS）评分明显小于K组（ P﹤0.05）；入PACU时及术后0.5，2，4 h，G组Ramsay评分明显优于K组（ P﹤0.05）；G组术后早期使用舒芬太尼、术后24 h电子泵按压的发生率明显低于K组（ P﹤0.05）；两组术后头晕、恶心、呕吐发生率比较，差异无统计学意义（ P﹥0.05），G组躁动发生率明显低于K组（ P﹤0.05）。术后2个月门诊随访，G组VAS评分显著优于K组（ P﹤0.05），而术后6个月两组VAS评分比较无显著性差异（ P﹥0.05）。结论加巴喷丁能提供有效的术后镇痛，较常规剂量氯胺酮的镇痛效果更强，且能显著减少阿片类药物的用量，降低术后慢性疼痛的发生率，值得临床推广。%Objective To compare the analgesic efficacy of gabapentin and ketamine for acute and chronic postoperative pains for pa-tients underwent hysterectomy. Methods 60 patients underwent hysterectomy were selected and randomly divided into ketamine group (group K)and gabapentin group(group G),30 cases in each group. In group K,patients were administered with 50 mg of victim C at the preoperative 2 h,then a loading dose of ketamine 0. 5 mg∕kg at the beginning of anesthesia,and a maintenance dose of ketamine at 0. 25 mg∕ ( kg·h ) during entire operation. In group G,patients were given gabapentin at a dose of 600 mg 2 h before operation,and 0. 9% sodium chloride with an equal volume of ketamine were injected as a loading dose and continuous infusion volume before and during operation. Two groups of patients were given remifentanil,propofol,cis atracurium induction and maintenance of anesthesia in order to achieve preemptive analgesia. The analgesia efficacy of the two groups were observed and compared. Results The VAS scores at the 0 h(in the PACU),and postoperative 0. 5,2,4,24 h in the group G were significantly less than those in the group K( P ﹤ 0. 05);the Ramsay scores at the 0 h(in the PACU),and postoperative 0. 5,2,4 h in the group G were significantly better than those in the group K( P ﹤ 0. 05);uses of sulfentanyl at the early postoperative time and times of pressing electronic pain control pump within post-operative 24 h in the group G were significantly less than those in the group K( P ﹤ 0. 05);the incidence rate of postoperative dizzi-ness,nausea,and vomiting showed no statistically significant differences between the two groups( P ﹥ 0. 05),additionally,restlessness in the group G was significantly less than that in the group K( P ﹤ 0. 05). Follow-up at the postoperative 2 month showed that VAS score in the group G were significantly less than that in the group K( P ﹤ 0. 05). Further follow-up at the postoperative 6 months found no statistically significant differences between the two groups( P ﹥ 0. 05). Conclusion In hysterectomy,gabapentin can provide more effective postoperative analgesia than ketamine at the commonly used doses. Furthermore,gabapentin can decrease postoperative con-sumption of opioid analgesics and reduce occurrences of chronic postoperative pain,which is worthy of clinical promotion.