S-氯胺酮镇痛作用的临床应用进展

Progress in the clinical application of the analgesic effect of S-ketamine

氯胺酮是一种N-甲基-D-天冬氨酸(NMDA)受体的非竞争性拮抗药,是左旋及右旋两种对映异构体的消旋体。S-氯胺酮为氯胺酮的右旋异构体,与NMDA受体的亲和力是外消旋氯胺酮的2倍,因此镇痛效价更强、不良反应更少。研究证明NMDA受体与急性疼痛的产生和慢性疼痛的发展相关,在围术期使用S-氯胺酮是一种可取的策略,提供了镇痛的非阿片机制途径,但其最佳的使用途径及方法仍需要进行不断的研究。

Ketamine is a noncompetitive antagonist of the N-methyl-D-aspartate(NMDA)receptor and is the racemate of both the levorotatory and dextorotatory isomers.S-Ketamine is the dextorotatory isomer of ketamine and has twice affinity for the NMDA receptor than racemic ketamine,resulting in greater analgesic potency and fewer adverse effects.Studies have demonstrated that NMDA receptors are associated with the generation of acute pain and the development of chronic pain,and the use of S-ketamine in the perioperative period is a desirable strategy that provides a non-opioid mechanistic route to analgesia,but its optimal route and method of use still require ongoing research.This article will summarize and review the recent literature related to perioperative analgesia with S-ketamine.