小剂量氯胺酮对腹腔镜胆囊切除术患者术后内脏痛的影响  

Effect of low dose ketamine on visceral pain following laparoscopic cholecystectomy

作　　者：吴长毅[1] 岳峰[1] 张利萍[1] 

机构地区：[1]北京大学第三医院麻醉科,北京100191

出　　处：《中国新药杂志》2014年第22期2651-2654,共4页Chinese Journal of New Drugs

摘　　要：目的：观察小剂量氯胺酮对腹腔镜胆囊切除术患者术后内脏痛的影响。方法：60例择期腹腔镜胆囊切除术患者,25-57岁,ASA分级Ⅰ-Ⅱ级,随机分为3组：对照组（C组）仅给予生理盐水;布比卡因组（B组）在手术结束时采用0.25%布比卡因20 m L局部浸润伤口;氯胺酮组（K组）在切皮前静脉给予0.3mg·kg-1氯胺酮,并于手术结束时采用0.25%布比卡因20 m L局部浸润伤口。分别于术后1,4,24 h采用视觉模拟评分法（VAS）评价患者切口痛及内脏痛疼痛程度,记录镇痛药物（曲马多和哌替啶）用量和首次需要镇痛药物时间,以及肩痛、恶心呕吐、恶梦和幻觉等不良反应的发生率。结果：与C组相比,B组患者术后1 h和4 h切口痛VAS评分显著降低（P〈0.05）,但相应时间点内脏痛VAS评分差异无显著性（P〉0.05）。与B组比较,K组患者术后1 h和4 h切口痛VAS评分差异无显著性（P〉0.05）,但相应时间点内脏痛VAS评分显著降低（P〈0.05）。术后24 h,3组患者切口痛及内脏痛VAS评分比较差异无显著性（P〉0.05）。C组镇痛药物用量显著高于B组和K组（P〈0.05）,且首次需要镇痛药物的时间也显著短于B组和K组（P〈0.01）,但B组和K组之间上述指标差异无显著性（P〉0.05）。3组患者术后不良反应发生率比较差异无显著性（P〉0.05）。结论：小剂量氯胺酮可减轻腹腔镜胆囊切除术患者术后内脏痛。Objective： To explore the effect of low dose ketamine on visceral pain in patients undergoing laparoscopic cholecystectomy. Methods： Sixty patients undergoing laparoscopic cholecystectomy were randomized assigned to one of three groups. The patients received placebo（ preincisional iv saline,control）,local infiltration with 20 m L bupivacaine at the end of surgery,or preincisional iv ketamine（ 0. 3 mg·kg- 1） and local infiltration with 20 m L bupivacaine at the end of surgery. All the patients had a standard anesthetic. Tramadol and meperidine were used for postoperative analgesia. Visual analogue scale scores（ VAS） for incisional and visceral pain at 1,4and 24 h,cumulative analgesic consumption and time until first analgesic medication request,and adverse effects were recorded. Results： At 1 and 4 h after operation,the VAS scores of incisional pain were significantly lower in bupivacaine alone group than in control group（ P〈 0. 01）,but the visceral pain scores were not different between the two groups（ P〉 0. 05）. At 1 h and 4 h after operation,the VAS scores of incisional pain did not differ significantly between groups with bupivacaine alone or ketamine ＋ bupivacaine（ P〉 0. 05）,but the VAS scores of visceral pain were significantly lower in ketamine ＋ bupivacaine group than in bupivacaine alone group at 1 h and 4 h after operation（ P〈 0. 05）. At 24 h after operation,visceral pain and incisional pain scores showed no statistical differ-ences between the three groups（ P 〉0. 05）. The consumption of analgesics was significantly higher in control group than in both the bupivacaine groups with or without ketamine（ P〈 0. 05）,and no statistical difference was found between the bupivacaine groups（ P〉 0. 05）. The time to first request for analgesics was significantly longer in both the bupivacaine groups than in control group（ P 〈0. 01）. There was no difference between the three groups regarding incidence of shoulder pain or adverse effects. Conclusion

关 键 词：氯胺酮 腹腔镜胆囊切除术 镇痛 内脏痛 

分 类 号：R971[医药卫生—药品]