Guillou Nicolas, Tanguy Michèle, Seguin Philippe, Branger Bernard, Campion Jean-Pierre, Mallédant Yannick
*Surgical Intensive Care Unit, †Biostatistical Unit, and ‡Surgical Unit, Hôpital Pontchaillou, Rennes, France.
Anesth Analg. 2003 Sep;97(3):843-847. doi: 10.1213/01.ANE.0000075837.67275.36.
In a randomized, double-blinded study, we evaluated the analgesic effect of ketamine in the management of pain in a surgical intensive care unit after major abdominal surgery. Patients received morphine patient-controlled analgesia with either placebo (Group M) or ketamine (Group K). Morphine was administered with initial loading doses of 2 mg until the visual analog scale (VAS) score was <30 and thereafter with bolus doses of 1 mg and a lockout time of 7 min. Ketamine was administered with an initial bolus of 0.5 mg/kg followed by a perfusion of 2 micro g x kg(-1) x min(-1) during the first 24 h and 1 micro g x kg(-1) x min(-1) during the following 24 h. The 4-h cumulative morphine doses were measured over 48 h. The VAS scores at rest and at mobilization were measured every 4 h during 48 h. A total of 101 patients were enrolled, and 93 were analyzed (41 in Group K and 52 in Group M). VAS scores at rest and at mobilization were similar. The cumulative consumption of morphine was significantly smaller in Group K (P < 0.05). We concluded that small doses of ketamine were a valuable adjunct to opioids in surgical intensive care unit patients after major abdominal surgery.
在一项随机双盲研究中，我们评估了氯胺酮在腹部大手术后外科重症监护病房疼痛管理中的镇痛效果。患者接受吗啡患者自控镇痛，分为安慰剂组（M组）或氯胺酮组（K组）。给予吗啡初始负荷剂量2mg，直至视觉模拟评分（VAS）<30，之后给予1mg推注剂量，锁定时间为7分钟。氯胺酮初始推注剂量为0.5mg/kg，随后在前24小时以2μg·kg⁻¹·min⁻¹的速度输注，接下来24小时以1μg·kg⁻¹·min⁻¹的速度输注。在48小时内测量4小时累积吗啡剂量。在48小时内每4小时测量静息和活动时的VAS评分。共纳入101例患者，93例进行分析（K组41例，M组52例）。静息和活动时的VAS评分相似。K组吗啡累积消耗量显著较少（P<0.05）。我们得出结论，小剂量氯胺酮是腹部大手术后外科重症监护病房患者阿片类药物的有价值辅助药物。
