目的:观察静脉应用小剂量氯胺酮超前镇痛法对接受腹腔镜下子宫切除手术患者术后疼痛及认知功能的影响。方法:38例择期接受腹腔镜下子宫切除术患者(ASA分级12)随机分为氯胺酮组和对照组。氯胺酮组于手术开始前5min静脉滴注氯胺酮015mg·kg-1,术中持续泵注3μg·kg-1·min-1至手术结束;对照组使用生理盐水。记录术中使用氯胺酮后心率,平均动脉压的变化;术后24h内静脉使用芬太尼的剂量,VAS疼痛评分,头晕、恶心、呕吐等不良反应,中枢神经系统症状以及术后2h患者认知功能。结果:两组患者在24h内静脉使用芬太尼的剂量,VAS疼痛评分,不良反应,中枢神经系统症状以及术后2h的认知功能方面没有统计学差异。〖HTH〗结论:〖HTSS〗静脉使用小剂量氯胺酮超前镇痛并不能减少术后芬太尼的用量,不能降低术后疼痛评分。尽管使用小剂量氯胺酮并没有增加患者术后的不良反应,也不影响患者术后认知功能障碍,不建议作为腹腔镜下子宫切除术患者常规使用。
Citation：
JIANG Hua,LEN Yan.. Effect of LowDose Ketamine on Postoperative Pain and Cognitive Function after Laparoscopic Hysterectomy. West China Medical Journal, 2009, 24(5): 1094-1096. doi:
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- 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,1998,77:923928.
- 2. KEHLET H. Postoperative opioid sparing to hasten recovery what are the issues?[J]Anesthesiology,2005,102:10831085.
- 3. 黄晓波,许婷,齐国华.氯胺酮在超前镇痛中的应用[J].实用医院临床杂志,2008,1(5):911.
- 4. WOOLF C J, THOMPSON S W. The induction and maintenance of central sensitization is dependent on NmethylDaspartate acid receptor activation: implication for the treatment of postinjury pain hypersensitivity states[J]. Pain,1991,44:293299.
- 5. DE KOCK M, LAVAND HOMME P, WATERLOOS H. "Balanced analgesia" in the perioperative period: is there a place for ketamine?[J] Pain,2001,92:373380.
- 6. ELIA N, TRAMER M R. Ketamine and postoperative paina quantitative systematic review of randomized trials[J]. Pain,2005,113:6170.
- 7. KATH S, BALACH S, RICHARD A. Ketamine as adjuvant analgesic to opioids: A quantitative and qualitative systematic review[J]. Anesth Analg,2004,99:482495.
- 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,2004,99:15751579.
- 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,1994,51:199214.
- 10. SCHMID R l, SANDLER A N, KATZ J. Use and efficacy of lowdose ketamine in the management of acute postoperative pain: A review of current techniques and outcomes[J]. Pain,1992,82:111125.
