目的 探讨硬膜外尿道前列腺电切术（TURP）中硬膜外给予氯胺酮预防寒战的效果。方法 93例择期硬膜外麻醉下实施TURP的男性患者纳入该研究。患者随机分为3组，1组31例硬膜外给予0.75%的罗哌卡因， 2组32例硬膜外给予0.2 mg/kg的氯胺酮加0.75%的罗哌卡因， 3组30例硬膜外给予0.4 mg/kg的氯胺酮加0.75%的罗哌卡因。记录麻醉过程中及麻醉后恢复室内2 h内寒战及低血压、心动过缓、恶心及幻觉等不良反应。结果 1组寒战发生在统计学上比另外两组发生要频繁，且低血压、心动过缓、恶心及幻觉等不良反应的发生率比另外两组要高（P<0.05）；3组产生镇静作用的发生率比另外两组都高（P<0.05）。结论 实施TURP手术患者，在硬膜外预防性应用低剂量氯胺酮，可有效减低不良反应及寒战的发生率。
Abstract
Objective To investigate the effect of epidural ketamine on shivering in transurethral resection of the prostate (TURP). Methods Ninety-three male patients scheduled for TURP under epidural anesthesia were enrolled in this study. Patients were randomly divided into three groups. Group 1 consisted of 31 patients who received epidural 0.75% ropivacaine, group 2 consisted of 32 patients who received epidural ketamine (0.2 mg/kg) in addition to 0.75% ropivacaine, and group 3 consisted of 30 patients who received epidural ketamine (0.4 mg/kg) in addition to 0.75% ropivacaine. Shivering and side effects such as hypotension, bradycardia, nausea, and hallucination were recorded during the anesthesia and for 2 hours while in the postanesthetic recovery room. Results Shivering was statistically more frequent in group 1 than in the other groups and the incidences of side effects such as hypotension, bradycardia, and nausea were significantly higher in group 1 than in the other groups (P<0.05). The incidence of sedation was significantly higher in group 3 than in the other groups (P<0.05). Conclusions In patients who undergo TURP under epidural anesthesia, the prophylactic use of low-dose epidural ketamine would be helpful in preventing any adverse effects, including shivering.
关键词
硬膜外麻醉 /
氯胺酮 /
寒战 /
经尿道前列腺电切术
Key words
epidural anesthesia /
ketamine /
shivering /
TURP
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参考文献
［1］ Winter M. Effects of irrigation fluid warming on hypothermia during urologic surgery［J］. Urol Nurs, 1994,14(1):6-8.
［2］ Chan A M, Ng K F, Tong E W, et al. Control of shivering under regional anesthesia in obstetric patients with tramadol［J］. Can J Anaesth,1999,46(3):253-258.
［3］ Buggy D J, Crossley A W. Thermoregulation, mild perioperative hypothermia and postanaesthetic shivering［J］. Br J Anaesth,2000,84(5):615-628.
［4］ Crossley A W, Mahajan R P. The intensity of postoperative shivering is unrelated to axillary temperature［J］. Anaesthesia, 1994,49(3):205-207.
［5］ Webb P J, James F M, Wheeler A S. Shivering during epidural analgesia in women in labor［J］. Anesthesiology, 1981,55(6):706-707.
［6］ Chan V W, Morley-Forster P K, Vosu H A. Temperature changes and shivering after epidural anesthesia for cesarean section［J］. Reg Anesth,1989,14(1):48-52.
［7］ Tsai Y C, Chu K S. A comparison of tramadol, amitriptyline, and meperidine for postepidural anesthetic shivering in parturients［J］. Anesth Analg, 2001,93(5):1288-1292.
［8］ Sessler D I, Ponte J. Shivering during epidural anesthesia［J］. Anesthesiology， 1990,72(5):816-821.
［9］ Matsukawa T, Sessler D I, Christensen R, et al. Heat flow and distribution during epidural anesthesia［J］. Anesthesiology, 1995,83(5):961-967.
［10］ Ozaki M, Kurz A, Sessler D I, et al. Thermoregulatory thresholds during epidural and spinal anesthesia［J］. Anesthesiology, 1994,81(2):282-288.
［11］ Bilotta F, Pietropaoli P, La Rosa I, et al. Effects of shivering prevention on haemodynamic and metabolic demands in hypothermic postoperative neurosurgical patients［J］. Anaesthesia, 2001;56:514-519.
［12］ Piper S N, Suttner S W, Schmidt C C, et al. Nefopam and clonidine in the prevention of postanaesthetic shivering［J］. Anaesthesia, 1999,54(7):695-699.
［13］ Sagir O, Gulhas N, Toprak H, et al. Control of shivering during regional anaesthesia: prophylactic ketamine and granisetron［J］. Acta Anaesthesiol Scand, 2007,51(1):44-49.
［14］ Honarmand A, Safavi M R. Comparison of prophylactic use of midazolam, ketamine, and ketamine plus midazolam for prevention of shivering during regional anaesthesia: a randomized double-blind placebo controlled trial［J］. Br J Anaesth, 2008,101(4): 557-562.
［15］ Nishiyama T, Yokoyama T, Hanaoka K. Sedation guidelines for midazolam infusion during spinal and epidural anesthesia［J］. J Clin Anesth, 2004,16(8): 568-572.
［16］ Shinozaki M, Usui Y, Yamaguchi S, et al. Recovery of function after propofol sedation is prolonged in the elderly［J］. Can J Anaesth, 2002,49(9):927-931.
［17］ Subramaniam B, Subramaniam K, Pawar D K, et al. Preoperative epidural ketamine in combination with morphine does not have a clinicallyrelevant intra- and postoperative opioid-sparingeffect［J］. Anesth Analg, 2001,93(5):1321-1326.
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