小剂量氯胺酮对子宫颈癌患者围术期炎性细胞因子及术后疼痛的影响

Effects of Low-dose Ketamine on Perioperative Cytokine Response and Postoperative Pain in Cervical Cancer Patients

目的探讨小剂量氯胺酮对子宫颈癌患者围术期炎性细胞因子及术后疼痛的影响。方法 65例子宫颈癌择期手术患者随机分为氯胺酮组(n=31)和对照组(n=34)。麻醉诱导后,氯胺酮组术前给予氯胺酮0.3 mg·kg-1静注,随后持续静注氯胺酮4μg·kg-1·min-1直至术毕;对照组给予相同容量的生理盐水静注。两组分别于麻醉诱导前、术后2 h及术后24 h抽取外周静脉血检测血清肿瘤坏死因子-α(Tumor necrosis factor–alpha,TNF-α)、白细胞介素-6(interleukin-6,IL-6)及白细胞介素-8(interleukin-8,IL-8)的浓度。采用视觉模拟评分(visual analogue scale,VAS)评估两组术后2 h、24 h和48 h的疼痛评分。结果两组血清TNF-α、IL-6和IL-8水平均在术后升高(P<0.05),氯胺酮组术后2 h、24 h的TNF-α、IL-6、IL-8水平较对照组偏低(P<0.05)。氯胺酮组术后2 h及术后24 h的VAS评分显著低于对照组(P<0.05)。结论小剂量氯胺酮有助于减轻子宫颈癌患者术后疼痛程度,抑制炎性细胞因子的升高。

Objective To investigate the effects of low-dose ketamine on perioperative cytokine response and postoperative pain in cervical cancer patients. Methods A total of 65 patients who underwent cervical cancer surgical procedures were randomized into ketamine group（n=31） and control group（n=34）. After induction of general anesthesia, patients in ketamine group received preoperative intravenous ketamine 0.3 mg·kg-1 and then continued intravenous ketamine 4 μg·kg-1·min-1 until surgery completed. Patients in control group were given the same volume of saline injection. The levels of tumor necrosis factor-alpha（TNF-α）, interleukin-6（IL-6） and interleukin-8（IL-8） from peripheral venous blood were assessed at the time points of before anesthesia induction, 2 hours and 24 hours after operation. Postoperative pain was evaluated using visual analogue scale（VAS） at 2 hours, 24 hours and 48 hours respectively after surgery. Results The levels of TNF-α, IL-6 and IL-8 in both groups increased postoperatively（P〈0.05）, and the levels of TNF-α, IL-6 and IL-8 in ketamine group were lower than those in the control group at 2 hours and 24 hours after surgery（P〈0.05）. VAS scores in ketamine group were significantly lower than in control group at 2 hours and 24 hours after surgery（P〈0.05）. Conclusion Low-dose ketamine can relieve the severity of postoperative pain and regulate the serum levels of cytokine in cervical cancer patients.