资源描述：
《氯胺酮辅以地塞米松术前用药对腹腔镜胆囊切除术后疼痛的影响.doc》由会员上传分享，免费在线阅读，更多相关内容在学术论文-天天文库。
1、氯胺酮辅以地塞米松术前用药对腹腔镜胆囊切除术后疼痛的影响作者：朱蔚琳，张学刚，宁加娟【摘要】目的：探讨氯胺酮在腹腔镜胆囊切除术（laparoscopiccholecystectomy,LC）后超前镇痛作用及地塞米松对氯胺酮超前镇痛的影响。方法：将60例患者随机分为3组(每组20例)：A组(氯胺酮组）;B组(氯胺酮+地塞米松组);C组(对照组)生理盐水2ml。对术后1h、2h、4h、6h、12h及术后1d、2d、3d切口痛及非切口痛分别进行VAS镇痛评分和术后镇静评分,记录术后不良反应及术后止痛药的需求情况。结果：术后非切口痛及
2、切口痛,A、B组VAS评分均较C组显著降低(P＜0.05);而A组与B组相比,术后VAS评分无明显差异(P>0.05)。术后恶心、呕吐发生率B组(20%)与A组(55%)、C组(60%)相比,明显降低(P＜0.05);A、Ｃ两组间无明显差异(P＞0.05);术后需要止痛药的例数A组3例(15%),B组3例(15%),C组9例(45%)(P＜0.05)。结论：氯胺酮辅以地塞米松在LC中能减轻术后疼痛,降低术后恶心、呕吐的发生率,具有超前镇痛作用,但地塞米松未使氯胺酮超前镇痛作用增强。 【关键词】胆囊切除术，腹腔镜;氯胺酮
3、;地塞米松;超前镇痛 【Abstract】Ｏbjective:Toexplorethepreventiveanalgesiaeffectsofketamineonpostoperativepaininpatientsundergonelaparoscopiccholecystectomy(LC)andwhetherdexamethasoneincreasetheeffectsofketamine.Methods:SixtypatientsundergoneLCwererandomlydividedintothreegroup
4、s(20patientseachgroup):Agroup(ketaminegroup),Bgroup(ketamineplusdexamethasonegroup),Cgroup(controlgroup).Incisionpainandnonincisionpainwasassessedat1h,2h,4h,6h,12hand1d,2d,3dafteroperationonavisualanaloguepainscale(VAS).Atthesametime,adverseeffectandanalgesicrequire
5、mentswererecorded.Results:PatientsingroupAandBhadlowerscoresonincisionpainandnonincisionpaincomparedwithgroupC(P<0.05).NosignificantdifferenceswerefoundbetweengroupAandBonVAS(P>0.05).IncidenceofpostoperativenauseaandvomitingsignificantlydecreaseingroupBcompare
6、dwithgroupAandC(P<0.05).Conclusions:Ketaminecombiningwithdexamethasonesignificantlyimprovedpostoperativeanalgesiaafterlaparoscopiccholecystectomyandreducedpostoperativenauseaandvomiting.However,dexamethasonedidnotincreaseeffectsofketamineonpostoperativepain. 【Ke
7、ywords】Cholecystectomy,laparoscopic;Ketamine;Dexamethasone;Preventive4analgesia 腹腔镜胆囊切除术(laparoscopiccholecystectomy,LC)与传统开腹手术相比,住院时间短,恢复快,术后疼痛轻;但也伴有内脏痛、肩痛、切口痛等,如治疗不当则会转为慢性疼痛,有时比开腹手术后疼痛持续时间更长［１］。目前,腹腔镜术后镇痛原则是个体化、多元化治疗,以降低阿片类药用量、促进尽早康复、离院为目标［23］。据研究表明,氯胺酮和地塞米松具有超前镇
8、痛作用,能减少术后阿片类药的用量,适合于腹腔镜术后镇痛,但其作用尚有争议。为此,我们探讨氯胺酮在LC术后超前镇痛作用及地塞米松对氯胺酮超前镇痛的影响,为临床应用提供依据。 1资料与方法 11临床资料选择ASAI～II级择期LC患者60例,其中男37例,女23例;25～60
