小剂量氯胺酮辅助芬太尼镇痛对患者术后C-反应蛋白和白细胞介素-6的影响

THE EFFECTS OF FENTANYL PLUS LOW-DOSE KETAMINE ON POSTOPERATIVE SERUM LEVELS OF CRP AND IL-6

摘要:

目的：观察小剂量氯胺酮辅助芬太尼术后镇痛效果以及对患者术后血清C-反应蛋白（CRP）和白细胞介素-6（IL-6）水平的影响。方法：择期全身麻醉下行上腹部手术患者60例，随机分为三组，Ⅰ组患者不接受静脉自控镇痛（PCIA）；Ⅱ组患者以芬太尼行PCIA；Ⅲ组患者以芬太尼＋氯胺酮行PCIA。监测患者术后48h内生命体征、疼痛视觉模拟评分（VAS）、焦虑视觉模拟评分（AVAT）以及患者对镇痛治疗的总体印象评分（PJA）。分别于术前和术后抽取静脉血测定血清CRP和IL-6浓度。随访镇痛相关并发症。结果：Ⅱ、Ⅲ组患者术后生命体征、VAS、AVAT、PJA明显优于Ⅰ组（P＜0．05）；Ⅲ组患者VAS、AVAT、PJA优于Ⅱ组（P＜0．05）。患者术后血清CRP和IL-6浓度Ⅱ、Ⅲ组低于Ⅰ组（P＜0．05）；Ⅲ组患者低于Ⅱ组（P＜0．05）。结论：术后镇痛中小剂量辅助使用氯胺酮可以在一定程度上降低炎症反应，缓解手术后应激反应，提高术后镇痛效果。

Abstract:

Objective:To investigate the effect of postoperative analgesia with fentanyl and low-dose ketamine and the influence on the levels of serum CRP and IL-6.Methods: Sixty patients were divided into three groups randomly: group I(without patient-controlled intravenous analgesia(PCIA)),group II (PCIA with fentanyl),and group III(PCIA with fentanyl plus low-dose ketamine). The vital signs within 48 h,VAS,anxiety visual analog test(AVAT) and the patient`s judgments on analgesia(PJA) were measured.Blood samples were taken before and after the surgery to assay the levels of serum CRP and IL-6.The complications of analgesia were followed up.Results:The vital signs,VAS,AVAT and PJA of the group II and group III were significantly better than those of the group I(P<0.05).The VAS,AVAT and PJA of the group III were better than those of the group II(P<0.05).The postoperative levels of serum CRP and IL-6 of the group II and III were lower than that of group I(P<0.05),and group III lower than group II(P<0.05).Conclusion: Low-dose ketamine can help decrease the inflammatory response and postoperative stress,and enhance the analgesic effect.