朱波 1 , 劉凌 2
  • 1 成都市第二人民醫(yī)院麻醉科（成都，610017）;2 成都市鐵路分局醫(yī)院麻醉科;

【摘要】 目的  觀察在腹腔鏡膽囊切除術(shù)中，氯胺酮超前鎮(zhèn)痛對瑞芬太尼麻醉后急性疼痛的影響。 方法  2009年10月-2010年1月，將擇期行腹腔鏡膽囊切除術(shù)患者90例，隨機分為對照組（C組）、氯胺酮超前鎮(zhèn)痛組（K組）、氯胺酮術(shù)畢鎮(zhèn)痛組（K1組），每組30例。所有患者均采用瑞芬太尼復合丙泊酚靜脈麻醉，K組在切皮前靜脈給予氯胺酮0.5 mg/kg，K1組在關(guān)腹前靜脈給予氯胺酮0.5 mg/kg，C組不給予任何藥物。記錄術(shù)畢患者麻醉恢復情況，各時間點疼痛程度。 結(jié)果  K組、K1組躁動發(fā)生率均明顯低于C組（P lt;0.05）；術(shù)后2、4、8、24 h，K組VAS評分及鎮(zhèn)痛藥使用率明顯低于C組和K1組（P lt;0.05）。 結(jié)論  氯胺酮超前鎮(zhèn)痛能明顯降低瑞芬太尼術(shù)后疼痛，并且不增加并發(fā)癥發(fā)生率。
【Abstract】 Objective  To evaluate the preemptive analgesia of ketamine on remifentanil induced acute postoperative pain after laparoscopic cholecystectomy. Methods  Ninty patients scheduled for laparoscopic cholecystectomy between october 2009 to Jannary 2010 were randomly assigned to three groups (n=30). Group K was administrated with 0. 5 mg/kg ketamine intravenously before skin incision, and Group K1 were administrated with 0. 5 mg/kg ketamine intravenously before abdominal closure, while Group C received nothing. The recovery and the side effects were recorded, the VAS at two, four, eight and 24 hours after surgery, and the use of anodyne were recorded. Results  The incidence of restlessness in Groups K and K1 was remarkably lower than that of Group C (P lt;0. 05). The analgesic effects two, four, eight and 24 hours after surgery were obviously better in group K than those of Group C and Group K1 (P lt;0. 05). Conclusion  Ketamine can produce preemptive analgesia to relieve remifentanil-induced acute pain, and it would not increase incidence of side effects.

引用本文： 朱波,劉凌. 氯胺酮超前鎮(zhèn)痛預防瑞芬太尼麻醉后急性疼痛的臨床研究. 華西醫(yī)學, 2010, 25(8): 1523-1524. doi: 復制

1. Tirault M, Derrode N, Clevenot D, et al. The effect of nefopam on morphine overconsumption induced by large-dose remifentanil during propofol anesthesia for major abdominal surgery[J]. Anesth Analg, 2006, 102(1): 110-117.
2. Amin HM, Sopchak AM, Esposito BF, et al. Naloxone-induced and spontaneous reversal of depressed ventilatory responses to hypoxia during and after continuous infusion of remifentanil or alfentanil[J]. J Pharmacol Exp Ther, 1995, 274(1): 34-39.
3. Glass PS, Gan TJ, Howell S. A review of the pharmacokinetics and pharmacodynamics of remifentanil[J]. Anesth Analg, 1999, 89(4 Suppl): S7-S14.
4. Laulin JP, Maurette P, Corcuf JB, et al. The role of ketamine in preventing fentanyl induced hyperalgesia and subsequent acute morphine tolerance[J]. Anesth Analg, 2002, 94(5): 1263-1269.
5. Hansen EG, Duedahl TH, Romsing J, et al. Intra-operative remifentanil might influence pain levels in the immediate post-operative period after major abdominal surgery[J]. Acta Anaesthesiol Scand, 2005, 49(10): 1464-1470.
6. Célèrier E, Laulin J, Larcher A, et al. Evidence for opiate-activated NMDA processes masking opiate analgesia in rats[J]. Brain Res, 1999, 847(1): 18-25.
7. Beilin B, Bessler H, Mayburd E. Effects of preemptive analgesia on pain and cytokine production in the postoperative period[J]. Anesthesiology, 2003, 98(1): 151-155.
  1. 1. Tirault M, Derrode N, Clevenot D, et al. The effect of nefopam on morphine overconsumption induced by large-dose remifentanil during propofol anesthesia for major abdominal surgery[J]. Anesth Analg, 2006, 102(1): 110-117.
  2. 2. Amin HM, Sopchak AM, Esposito BF, et al. Naloxone-induced and spontaneous reversal of depressed ventilatory responses to hypoxia during and after continuous infusion of remifentanil or alfentanil[J]. J Pharmacol Exp Ther, 1995, 274(1): 34-39.
  3. 3. Glass PS, Gan TJ, Howell S. A review of the pharmacokinetics and pharmacodynamics of remifentanil[J]. Anesth Analg, 1999, 89(4 Suppl): S7-S14.
  4. 4. Laulin JP, Maurette P, Corcuf JB, et al. The role of ketamine in preventing fentanyl induced hyperalgesia and subsequent acute morphine tolerance[J]. Anesth Analg, 2002, 94(5): 1263-1269.
  5. 5. Hansen EG, Duedahl TH, Romsing J, et al. Intra-operative remifentanil might influence pain levels in the immediate post-operative period after major abdominal surgery[J]. Acta Anaesthesiol Scand, 2005, 49(10): 1464-1470.
  6. 6. Célèrier E, Laulin J, Larcher A, et al. Evidence for opiate-activated NMDA processes masking opiate analgesia in rats[J]. Brain Res, 1999, 847(1): 18-25.
  7. 7. Beilin B, Bessler H, Mayburd E. Effects of preemptive analgesia on pain and cytokine production in the postoperative period[J]. Anesthesiology, 2003, 98(1): 151-155.