小剂量氯胺酮不同给药模式对腹腔镜手术病人术后疼痛的影响

Effects of administering low dosage of Ketamine in different routs on postoperative pain after laparoscopic surgery

目的比较静脉推注和肌肉注射小剂量氯胺酮对妇科腹腔镜手术病人的超前镇痛作用。方法45例ASAⅠ～Ⅱ级择期行妇科腹腔镜手术的患者随机分成3组，每组15例。分别于麻醉诱导后3min静脉推注0．15mg／奴氯胺酮（V组）、肌肉注射0．15mg／kg氯胺酮（M组）和空白对照组（P组），术后1h、3h、6h、16h和24h分别记录疼痛评分（VAS）及恶心、呕吐、嗜睡、幻觉、做梦等副作用。结果V组和M组术后6h内VAS评分差异显著低于P组（P〈0．01），而在6h后3者VAS评分无显著差异；V、M组在术后各时点VAS评分均无明显差异（P〉0．05）；恶心、呕吐、嗜睡、幻觉、做梦等副作用发生率3组间差异无显著性。结论0．15mg／kg氯胺酮术前预先静脉推注或肌肉注射均可明显减轻腹腔镜手术病人术后疼痛，但氯胺酮肌肉注射可避免静脉给药后血药浓度高峰的过早出现，从而可增加氯胺酮术前给药的安全性，值得临床推荐使用。

Objective To compare the analgesic effects of administering low dosage of ketamine by intravenous injection or intramuscularly in women patients undergoing laparoscopic surgery for reducing pain. Methods 45 ASA physical status Ⅰ or Ⅱ patients scheduled for selective laparoscopic surgery were randomly assigned into 3 groups：0.15 mg/kg Ketamine administered intravenously （V group）,0.15 mg/kg Ketamine administered intramuscularly（M group）,and Saline administered intravenously（P group） at 3 min after general anesthetic induction. Visual analogue scale values were evaluated at 1,3,6,16 and 24 h after surgery, and the adverse effects were evaluated. Results Patients received preincision Ketamine（V or M group） had a low pain score in the first 6 h after operation compared with the placebo groups（P 〈 0.01）, and there was no significant difference among these three groups in the first 6 h. The difference of VAS scale between the V and M groups was not marked after surgery（P 〈 0.05）. No significant difference presented among groups with respect to adverse effects such as nausea, vomiting, somnolence, hallucination and daydreaming. Conclusion It is obvious that a small dose of Ketamine administered intravenously or intramuscularly will provide effective analgesic in patients undergoing laparoscopic surgery for administering ketamine intramuscularly can keep plasma drug concentration from reaching peak value preoperatively.