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目的 :观察硬膜外吗啡、氯胺酮加吗啡行超前镇痛的临床效果及对儿茶酚胺的影响。方法 :4 5例患者随机分为 3组 ,硬膜外穿刺成功后经硬膜外导管注入吗啡 2mg(BM组 ) ,氯胺酮 10mg加吗啡 2mg(KT +M )组 ,对照组于术毕注入吗啡 2mg(AM组 )。术后患者需镇痛时肌注哌替啶 75mg/次。观察镇痛效果 ,检测血浆NE、E、DA及CA变化。结果 :BM组与AM组相比 ,除运动时VAS评分降低外 (P <0 .0 5) ,其余观察指标差异无显著性 ,KT +M组与AM、BM组相比 ,首次要求镇痛时间延长 (P <0 0 5) ,肌注派替啶次数减少 (P <0 .0 5) ,休息时VAS评分降低 (P <0 .0 5) ,运动时VAS评分与BM组相似。 3组患者儿茶酚胺含量术后第 1天均高于术前值 (P <0 .0 1) ,术后第 3天下降 ,KT +M组下降最明显 ,与术后第 1天差异有高度显著性 (P <0 .0 1) ,接近术前值 ;BM组和AM组儿茶酚胺变化相似 ,术后第 3天低于术后第 1天 (P <0 .0 5) ,但仍明显高于术前值 (P <0 .0 5)。结论 :硬膜外吗啡超前镇痛与吗啡术后镇痛临床效果差异无显著性 ,联合应用氯胺酮和吗啡行超前镇痛效果较好 ,氯胺酮能增强吗啡的超前镇痛作用 ,且能有效地抑制术后疼痛所致的应激反应
Objective: To observe the clinical effect of epidural morphine, ketamine and morphine on preemptive analgesia and their effects on catecholamines. Methods: Forty-five patients were randomly divided into three groups. Morphine 2mg (BM), ketamine 10mg plus morphine 2mg (KT + M) were injected into the epidural catheter after successful epidural puncture. The control group was injected with morphine 2 mg (AM group). Postoperative patients required intramuscular injection of pethidine 75mg / time. The analgesic effect was observed and the change of plasma NE, E, DA and CA was measured. Results: Compared with AM group, the VAS score of exercise group was lower than that of AM group (P <0. 05), there was no significant difference between other groups in KT + M group and AM, BM group (P <0.05), the number of intramuscular injection of pyridine decreased (P <0.05), the VAS score at rest decreased (P <0.05), and the VAS score during exercise was similar to that of BM. The levels of catecholamine in the three groups were significantly higher than preoperative values (P <0.01) on the first postoperative day, decreased on the third postoperative day, and decreased significantly in the KT + M group, with a significant difference from the first postoperative day (P <0.01), which was close to the preoperative value. The changes of catecholamines in BM group and AM group were similar, and were lower than the first day after operation (P <0.05) on the third day after operation, but still significantly higher than Preoperative values (P <0.05). CONCLUSION: There is no significant difference in the clinical efficacy of epidural morphine analgesia and morphine postoperative analgesia. Ketamine and morphine combined with ketamine and morphine have better analgesic effect. Ketamine can enhance the preemptive analgesic effect of morphine and can effectively inhibit Postoperative pain-induced stress response