胆囊切除术_腹腔镜;氯胺酮;地塞米松;超前镇痛_

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

http://www.100md.com 《腹腔镜外科杂志》 2006年第6期

胆囊切除术,腹腔镜;氯胺酮;地塞米松;超前镇痛,,胆囊切除术，腹腔镜;氯胺酮;地塞米松;超前镇痛,1资料与方法,2结果,3讨论,参考文献：

     【摘要】目的：探讨氯胺酮在腹腔镜胆囊切除术(laparoscopic cholecystectomy,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1、2、4、6、12h及术后1、2、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：术后非切口痛及切口痛,A组、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,但地塞米松没有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;地塞米松;超前镇痛

    Effect of preoperative ketamine in combination with dexamethasone on postoperative pain after laparoscopic cholecystectomy

    ZHU Weilin,ZHANG Xuegang,NING Jiajuan.

    Department of Anesthesiology,Guangxi Zhuang Autonomous Region Hospital,Nanning 530021,China

    【Abstract】 Objective:To explore the effects of ketamine on severity of postoperative pain in patients undergoing laparoscopic cholecystectomy (LC)and whether dexamethasone increasing effects of ketamine on postoperative pain.Methods:Sixty consecutive patients undergoing LC who were randomly divided into three groups,20 patients in each group:A group(ketamine group),B group (ketamine plus dexamethasone group),C group(control group).Incision pain and nonincision pain was assessed at 1,2,4,6,12h and once each day for 3d postoperative on a visual analogue pain scale(VAS)at rest,At the same time,adverse effect and analgesic requirements were recorded.Results:Patients in Group A and B had lower scores for incision pain and nonincision pain compared with Group C (P<0.05).No differences were found between Group A and B on VAS (P>0.05).Incidence of postoperative nausea,and vomiting significantly decrease in group C compared with Group A and B.Conclusions:Ketamine in combination with dexamethasone significantly improved postoperative analgesia after laparoscopic cholecystectomy and reduced postoperative nausea,and vomiting.However,dexamethasone did not increase effects of ketamine on postoperative pain. ......

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