• 成都市第三人民醫(yī)院麻醉科,四川成都 610017;

目的:觀察靜脈應(yīng)用小劑量氯胺酮超前鎮(zhèn)痛法對(duì)接受腹腔鏡下子宮切除手術(shù)患者術(shù)后疼痛及認(rèn)知功能的影響。方法:38例擇期接受腹腔鏡下子宮切除術(shù)患者(ASA分級(jí)12)隨機(jī)分為氯胺酮組和對(duì)照組。氯胺酮組于手術(shù)開(kāi)始前5min靜脈滴注氯胺酮015mg·kg-1,術(shù)中持續(xù)泵注3μg·kg-1·min-1至手術(shù)結(jié)束;對(duì)照組使用生理鹽水。記錄術(shù)中使用氯胺酮后心率,平均動(dòng)脈壓的變化;術(shù)后24h內(nèi)靜脈使用芬太尼的劑量,VAS疼痛評(píng)分,頭暈、惡心、嘔吐等不良反應(yīng),中樞神經(jīng)系統(tǒng)癥狀以及術(shù)后2h患者認(rèn)知功能。結(jié)果:兩組患者在24h內(nèi)靜脈使用芬太尼的劑量,VAS疼痛評(píng)分,不良反應(yīng),中樞神經(jīng)系統(tǒng)癥狀以及術(shù)后2h的認(rèn)知功能方面沒(méi)有統(tǒng)計(jì)學(xué)差異?！糎TH〗結(jié)論:〖HTSS〗靜脈使用小劑量氯胺酮超前鎮(zhèn)痛并不能減少術(shù)后芬太尼的用量,不能降低術(shù)后疼痛評(píng)分。盡管使用小劑量氯胺酮并沒(méi)有增加患者術(shù)后的不良反應(yīng),也不影響患者術(shù)后認(rèn)知功能障礙,不建議作為腹腔鏡下子宮切除術(shù)患者常規(guī)使用。

引用本文： 姜華,冷燕. 靜脈應(yīng)用小劑量氯胺酮對(duì)腹腔鏡下子宮切除術(shù)后疼痛以及患者認(rèn)知功能的影響. 華西醫(yī)學(xué), 2009, 24(5): 1094-1096. doi: 復(fù)制

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5. DE KOCK M, LAVAND HOMME P, WATERLOOS H. "Balanced analgesia" in the perioperative period: is there a place for ketamine?[J] Pain,2001,92:373380.
6. ELIA N, TRAMER M R. Ketamine and postoperative paina quantitative systematic review of randomized trials[J]. Pain,2005,113:6170.
7. KATH S, BALACH S, RICHARD A. Ketamine as adjuvant analgesic to opioids: A quantitative and qualitative systematic review[J]. Anesth Analg,2004,99:482495.
8. VAN ELSTRAETE A C, LEBRUN T, SANDEFO I, et al. Are preemptive analgesic effects of ketamine linked to inadequate perioperative analgesia[J]. Anesth Analg,2004,99:15751579.
9. KRYSTAL J H, KARPER L P, SEIBYL J P, et al. Subanesthetic effects of the noncompetitive NMDA antagonist, ketamine, inhuman: psychotomimetic, perceptual, cognitive and neuroendocrine responses[J]. Arch Gen Psychiatry,1994,51:199214.
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  1. 1. ELLSTROM M, OLSEN M F, OLSSON J H, et al. Pain and pulmonary function following laparoscopic and abdominal hysterectomy: a randomized study[J]. Acta Obstet Gynecol Scand,1998,77:923928.
  2. 2. KEHLET H. Postoperative opioid sparing to hasten recovery what are the issues?[J]Anesthesiology,2005,102:10831085.
  3. 3. 黃曉波,許婷,齊國(guó)華.氯胺酮在超前鎮(zhèn)痛中的應(yīng)用[J].實(shí)用醫(yī)院臨床雜志,2008,1(5):911.
  4. 4. WOOLF C J, THOMPSON S W. The induction and maintenance of central sensitization is dependent on NmethylDaspartate acid receptor activation: implication for the treatment of postinjury pain hypersensitivity states[J]. Pain,1991,44:293299.
  5. 5. DE KOCK M, LAVAND HOMME P, WATERLOOS H. "Balanced analgesia" in the perioperative period: is there a place for ketamine?[J] Pain,2001,92:373380.
  6. 6. ELIA N, TRAMER M R. Ketamine and postoperative paina quantitative systematic review of randomized trials[J]. Pain,2005,113:6170.
  7. 7. KATH S, BALACH S, RICHARD A. Ketamine as adjuvant analgesic to opioids: A quantitative and qualitative systematic review[J]. Anesth Analg,2004,99:482495.
  8. 8. VAN ELSTRAETE A C, LEBRUN T, SANDEFO I, et al. Are preemptive analgesic effects of ketamine linked to inadequate perioperative analgesia[J]. Anesth Analg,2004,99:15751579.
  9. 9. KRYSTAL J H, KARPER L P, SEIBYL J P, et al. Subanesthetic effects of the noncompetitive NMDA antagonist, ketamine, inhuman: psychotomimetic, perceptual, cognitive and neuroendocrine responses[J]. Arch Gen Psychiatry,1994,51:199214.
  10. 10. SCHMID R l, SANDLER A N, KATZ J. Use and efficacy of lowdose ketamine in the management of acute postoperative pain: A review of current techniques and outcomes[J]. Pain,1992,82:111125.