| 周煦燕,孔敏,姜黎珊,沈徐,陆雅萍,姚明,黄兵.术前应用氯胺酮对乳腺癌患者术后慢性疼痛发生率的影响[J].中国临床保健杂志,2017,20(6):710-713. |
| 术前应用氯胺酮对乳腺癌患者术后慢性疼痛发生率的影响 |
| Effect of preoperaion use of NMDA receptor antagonist ketamine on the incidence of chronic pain after breast cancer surgery |
| 投稿时间：2017-08-10 |
| DOI：10.3969/J.issn.1672-6790.2017.06.024 |
| 中文关键词: 乳腺肿瘤 氯胺酮 慢性疼痛 痛阈 |
| 英文关键词: Breast neoplasms Ketamine Chronic pain Pain threshold 〖FL |
| 基金项目:浙江嘉兴市科学技术局计划(2014AY21024) |
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| 中文摘要: |
| 目的 观察超前应用NMDA受体拮抗剂氯胺酮对乳腺癌术后慢性疼痛发生率的影响。方法 ASA I或Ⅱ级全身麻醉下乳腺癌改良根治手术患者160例,采用随机数字表法将患者随机均分为N组(单纯全身麻醉组)和K组(全身麻醉+氯胺酮组)。记录患者术前1天、麻醉苏醒后即刻、术后24 h、48 h机械痛敏程度；采用视觉模拟评分法(VAS)评估患者术前1天、麻醉苏醒后即刻、术后24 h、48 h、2个月疼痛程度并统计两组慢性疼痛发生率；根据患者自行按压的患者自控镇痛(PCA)次数,计算术后芬太尼需要量。结果 术前两组健患侧痛阈及VAS评分测定差异无统计学意义,N组苏醒即刻健侧及患侧痛阈较术前明显降低,术后24 h及48 h健侧痛阈与术前无显著差异,K组健侧术后各时间点痛阈较术前无明显差异,两组患者苏醒即刻及术后24 h患侧痛阈虽然较术前都降低,但K组痛阈明显比N组高,差异有统计学意义(P＜0.05),术后48 h两组患侧痛阈差异无统计学意义(P>0.05)；患者术前VAS 评分均为0分,术后即刻及术后24 h K组比N组低,差异有统计学意义(P＜0.05),术后PCIA的按压次数及芬太尼使用量K组比N组明显减少,差异有统计学意义(P＜0.05)；术后K组慢性疼痛发生率比N组明显降低,差异有统计学意义(P＜0.05)。结论 麻醉诱导期给予氯胺酮能有效提高术中应用瑞芬太尼乳腺癌改良根治患者术后痛阈,降低了乳腺癌患者的慢性疼痛的发生率。 |
| 英文摘要: |
| Objective To observe the effect of preoperaion use of NMDA receptor antagonist ketamine on the incidence of chronic pain after breast cancer surgery.Methods 160 cases of patients with modified radical mastectomy for breast cancer under ASA Ⅰ or Ⅱ general anesthesia were randomly divided into group N (named as general anesthesia group) and group K (named as general anesthesia + ketamine group) by random number table.Record the mechanical hyperalgesia of postoperative 1 days before anesthesia,immediately after,24 hours and 48 hours after the operation;to evaluate the degree of chronic pain of patients before 1 days,immediately after anesthesia,after 24 hours and 48 hours by the VAS score,and the incidence of two groups patients by February statistics;to calculate the postoperative fentanyl requirement according to press the number of PCA.Results The preoperative health ipsilateral pain threshold and VAS score was no significant difference between the two groups,the immediate ipsilateral and contralateral pain threshold in N group were significantly lower than their preoperative index,the contralateral preoperative pain threshold at postoperative 24 hours and 48 hours had no significant difference compared with operation before.The healthy side at each time point after operation in K group had no obvious differences compared with operation before,the ipsilateral pain threshold after the surgery while and 24 hours decreased compared with preoperative,but pain threshold was higher in the K group than that of N group,the difference was statistically significant (P<0.05),lateral pain threshold after 48 hours of operation in the two groups had no significant difference between (P>0.05);the VAS score postoperative in patients was 0,it was lower at immediately after operation and 24 hours after operation in K group than in N group,the difference was statistically significant (P<0.05),postoperative PCIA Press Number and fentanyl use in K group was obviously lower than that of N group,the difference was statistically significant (P<0.05);the incidence of postoperative pain chronic in K group was statistically significant lower than that of the N group (P<0.05).Conclusion Ketamine can improve the pain threshold in patients undergoing modified radical mastectomy and reduce the incidence of chronic pain in patients with breast cancer. |
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