低剂量氯胺酮联合利多卡因超前镇痛对子宫肌瘤患者术后应激反应的作用研究  

The Preemptive Analgesia Effect of Low Dose Ketamine Combined with Lidocaine on Stress Response for Postoperative Patients with Uterine Myoma

作　　者：郭静[1] 王炳海[2] 托娅[1] 徐丽娜[1] 塔娜[1] 

机构地区：[1]内蒙古医科大学附属医院生殖医学中心,内蒙古呼和浩特010050 [2]内蒙古医科大学第二附属医院,内蒙古呼和浩特010050

出　　处：《肿瘤药学》2017年第2期219-223,共5页Anti-Tumor Pharmacy

摘　　要：目的探讨低剂量氯胺酮联合利多卡因超前镇痛对子宫肌瘤手术后患者应激反应及疼痛的影响,以期为降低术后疼痛及应激反应提供依据。方法选取拟行腹腔镜子宫肌瘤剔除术的子宫肌瘤患者150例,随机单盲法分为阳性对照组、阴性对照组和观察组,每组各50例。阳性对照组术后给予镇痛仪镇痛,阴性对照组给予氯胺酮超前镇痛,观察组给予低剂量氯胺酮联合利多卡因超前镇痛。观察三组患者手术情况、术后不同时间疼痛情况及应激反应情况。结果三组患者均顺利完成手术,三组手术时间、术中出血量、术后下床时间及肛门排气时间对比,差异无统计学意义(P>0.05);三组术后1 h视觉模拟评分(VAS)对比,差异无统计学意义(P>0.05),观察组术后6 h、、8 h、12 h、24 h VAS评分低于同组治疗前、阳性对照组同期、阴性对照组同期,差异均有统计学意义(P<0.05);观察组术后各项应激指标均高于术前,低于阳性对照组同期、阴性对照组同期,差异均有统计学意义(P<0.05);三组不良反应发生率比较,差异无统计学意义(P>0.05);观察组术后未服用镇痛药物,镇痛药物服用率低于阳性对照组和阴性对照组,差异有统计学意义(P<0.05)。结论子宫肌瘤剔除术患者采用低剂量氯胺酮联合利多卡因超前镇痛,可有效降低术后疼痛与应激反应,且不增加不良反应,值得临床推广。Objective To study the preemptive analgesia effects of low dose of ketamine combined with lidocaine on stress response for patients with myoma of uterus after the operation and offer more evidence and strategies to reduce postoperative pain and stress reaction. Methods 150 patients with uterine myoma who were planning to conduct laparoscopic myomectomy surgery were selected between January 2014 and January 2015 from the department of obstetrics and gynecology in our hospital. They were divided into positive control group, neg- ative control group and observation group by randomized single blind method, 50 cases for each group. The positive control group was given analgesic apparatus, and the negative control group was given ketamine preemptive analgesia, while the observation group given low dose of ketamine combined with hdocaine preemptive analgesia. Patients in the three groups were observed in the operation. The postoperative pain and stress responses including plasma epinephrine, norepinephrine and cortisol content were also observed and analyzed. Results Patients in three groups all completed successful operation. There were no statistically significant differences in the operation time, intraoperative bleeding volume, postoperative time of off-bed, anal exhaust time and postoperative 1 h visual simulation score （VAS） between the three groups （P〉0.05）. The VAS scores after 6 h, 8 h, 12 h, 24 h in the observation group were all lower than those before treatment in the same group and lower than those after 6 h, 8 h, 12 h, 24 h in the positive control group and the negative control group （P〈 0.05）. The stress indexes after operation in the observation group were higher than those before operation （P〈0.05）, but lower than those in the positive control group and the negative control group at the same period （P〈0.05）. The incidence rates of adverse reactions in the three groups had no statistically significant differences （P〉0.05）. No patient in observation group took analgesic d

关 键 词：低剂量氯胺酮 利多卡因 子宫肌瘤 应激反应 超前镇痛 

分 类 号：R737.33[医药卫生—肿瘤]