静脉应用小剂量氯胺酮对腹腔镜下子宫切除术后疼痛以及患者认知功能的影响

Effect of Low-Dose Ketamine on Postoperative Pain and Cognitive Function after Laparoscopic Hysterectomy

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1-2)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0.15mg.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。结论: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。

Objective： To examine the potential beneficial effect of low-dose ketamine on postoperative pain management and cognitive function of the patients receiving the laparoscopic hysterectomy. Methods： Thirty-eight patients were included in this double-blind, randomized, placebo-controlled study to test the efficacy and adverse effects of ketamine （as an preoperative bolus of 0.15 mg·kg^-1 , followed by ketamine 3μg·kg^-1·min 1 till the end of operate）. All patients received fentanyl in a patients-controlled analgesia device. The changes of HR, MAP after bolus of ketamine, and the fentanyl consumption of the first 24 h, the adverse effects and the results of cognitive function were recorded. Results： Preemptive ketamine did not improve postoperative pain scales and did not reduce fentanyl consumption. Ketamine did not modify cognitive function and did not increase adverse effects. Conclusion： Preemptive ketamine do not improve analgesia after laparoscopic hysterectomy. Although this adding appears to be safe, the lack of benefit suggests that low-dose of ketamine should not be used for routine care.