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目的：探讨氯胺酮、吗啡硬膜外腔术后镇痛效应和伍用后是否可提高镇痛效果并减少副作用。方法：５０例硬膜外腔麻醉下行骨科手术的患者，随机分为５组，每组１０例。Ａ组：吗啡０．０１ｍｇ／ｋｇ；Ｂ组：氯胺酮０．４ｍｇ／ｋｇ；Ｃ组氯胺酮０．６ｍｇ／ｋｇ；Ｄ组：Ａ＋Ｂ；Ｅ组：Ａ＋Ｃ。于术后４、８、１２、２４、４８、７２ｈ记录疼痛评分（ＶＡＰＳ）及副作用的发生情况。结果：Ａ组ＶＡＰＳ评分平均为２．９５，有效镇痛７例，平均持续时间为５２．０ｈ；Ｂ组镇痛效果差，ＶＡＰＳ评分平均为７．２６，有效镇痛３例，与Ａ组比较有统计学显著差异（Ｐ＜０．０１）；Ｃ组ＶＡＰＳ评分平均为３．６０，与Ａ组比较无统计学差异，有效镇痛７例，平均持续时间为４４．４ｈ；Ｄ组ＶＡＰＳ平均评分为２．７３，与Ａ组比较无统计学差异，平均持续时间为５０．８ｈ；Ｅ组平均ＶＡＰＳ评分为１．５８，与Ａ组比较有统计学显著差异（Ｐ＜０．０１），持续时间为５８．１ｈ。结论：１．氯胺酮０．４ｍｇ／ｋｇ硬膜外腔术后镇痛效果差，剂量增至０．６ｍｇ／ｋｇ镇痛效果与吗啡０．０１ｍｇ／ｋｇ相近，恶心、呕吐发生较少，无精神方面的副作用；２．氯胺酮与吗啡配伍，随着氯胺酮剂量增加到０．６ｍｇ／ｋｇ?
Objective: To investigate the postoperative analgesic effects of ketamine and morphine epidural and whether analgesic effects can be improved and the side effects reduced after administration. Methods: Fifty patients undergoing epidural surgery under epidural anesthesia were randomly divided into five groups (n = 10 in each group). Group A: morphine 0.01 mg / kg; Group B: ketamine 0.4 mg / kg; Group C ketamine 0.6 mg / kg; Group D: A + B; Group E: A + C. Pain scores (VAPS) and side effects were recorded at 4, 8, 12, 24, 48 and 72 h after surgery. Results: The average VAPS score of group A was 2.95, the effective analgesia was 7 and the average duration was 52.0 h. The analgesic effect of group B was poor, the average score of VAPS was 7.26, the effective analgesia was 3 cases, (P <0.01). The average VAPS score in group C was 3.60, there was no significant difference compared with group A, and the effective analgesia was in 7 cases with the average duration of 44.4 h. In group D, the VAPS The average score was 2.73, with no significant difference compared with group A, with an average duration of 50.8h. The mean VAPS score in group E was 1.58, which was significantly different from that in group A (P <0.01) , Duration of 58.1h. Conclusion: 1. Ketamine 0.4mg / kg postoperative epidural analgesic effect is poor, the dose increased to 0.6mg / kg analgesic effect similar to morphine 0.01mg / kg, nausea, vomiting occurred less, no mental side effects; 2. Ketamine and morphine compatibility, with ketamine dose increased to 0.6mg / kg?