低剂量氯胺酮联合利多卡因超前镇痛对子宫肌瘤患者术后应激反应的作用研究
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摘要
目的探讨低剂量氯胺酮联合利多卡因超前镇痛对子宫肌瘤手术后患者应激反应及疼痛的影响,以期为降低术后疼痛及应激反应提供依据。方法选取拟行腹腔镜子宫肌瘤剔除术的子宫肌瘤患者150例,随机单盲法分为阳性对照组、阴性对照组和观察组,每组各50例。阳性对照组术后给予镇痛仪镇痛,阴性对照组给予氯胺酮超前镇痛,观察组给予低剂量氯胺酮联合利多卡因超前镇痛。观察三组患者手术情况、术后不同时间疼痛情况及应激反应情况。结果三组患者均顺利完成手术,三组手术时间、术中出血量、术后下床时间及肛门排气时间对比,差异无统计学意义(P>0.05);三组术后1 h视觉模拟评分(VAS)对比,差异无统计学意义(P>0.05),观察组术后6 h、、8 h、12 h、24 h VAS评分低于同组治疗前、阳性对照组同期、阴性对照组同期,差异均有统计学意义(P<0.05);观察组术后各项应激指标均高于术前,低于阳性对照组同期、阴性对照组同期,差异均有统计学意义(P<0.05);三组不良反应发生率比较,差异无统计学意义(P>0.05);观察组术后未服用镇痛药物,镇痛药物服用率低于阳性对照组和阴性对照组,差异有统计学意义(P<0.05)。结论子宫肌瘤剔除术患者采用低剂量氯胺酮联合利多卡因超前镇痛,可有效降低术后疼痛与应激反应,且不增加不良反应,值得临床推广。
Objective To study the preemptive analgesia effects of low dose of ketamine combined with lidocaine on stress response for patients with myoma of uterus after the operation and offer more evidence and strategies to reduce postoperative pain and stress reaction. Methods 150 patients with uterine myoma who were planning to conduct laparoscopic myomectomy surgery were selected between January 2014 and January 2015 from the department of obstetrics and gynecology in our hospital. They were divided into positive control group, negative control group and observation group by randomized single blind method, 50 cases for each group. The positive control group was given analgesic apparatus, and the negative control group was given ketamine preemptive analgesia, while the observation group given low dose of ketamine combined with lidocaine preemptive analgesia. Patients in the three groups were observed in the operation. The postoperative pain and stress responses including plasma epinephrine, norepinephrine and cortisol content were also observed and analyzed. Results Patients in three groups all completed successful operation. There were no statistically significant differences in the operation time, intraoperative bleeding volume, postoperative time of off-bed, anal exhaust time and postoperative 1 h visual simulation score(VAS) between the three groups(P>0.05). The VAS scores after 6 h, 8 h, 12 h, 24 h in the observation group were all lower than those before treatment in the same group and lower than those after 6 h, 8 h, 12 h, 24 h in the positive control group and the negative control group(P<0.05). The stress indexes after operation in the observation group were higher than those before operation(P<0.05), but lower than those in the positive control group and the negative control group at the same period(P<0.05). The incidence rates of adverse reactions in the three groups had no statistically significant differences(P>0.05). No patient in observation group took analgesic drugs after operation. The rate of taking analgesic drug in the observation group was lower than in the positive control group and the negative control group(P<0.05). Conclusion Patients using low dose of ketamine combined with lidocaine preemptive analgesia can alleviate postoperative pain and reduce the stress response, but do not increase adverse reactions, so it is worthy of clinical promotion.
Objective To study the preemptive analgesia effects of low dose of ketamine combined with lidocaine on stress response for patients with myoma of uterus after the operation and offer more evidence and strategies to reduce postoperative pain and stress reaction. Methods 150 patients with uterine myoma who were planning to conduct laparoscopic myomectomy surgery were selected between January 2014 and January 2015 from the department of obstetrics and gynecology in our hospital. They were divided into positive control group, negative control group and observation group by randomized single blind method, 50 cases for each group. The positive control group was given analgesic apparatus, and the negative control group was given ketamine preemptive analgesia, while the observation group given low dose of ketamine combined with lidocaine preemptive analgesia. Patients in the three groups were observed in the operation. The postoperative pain and stress responses including plasma epinephrine, norepinephrine and cortisol content were also observed and analyzed. Results Patients in three groups all completed successful operation. There were no statistically significant differences in the operation time, intraoperative bleeding volume, postoperative time of off-bed, anal exhaust time and postoperative 1 h visual simulation score(VAS) between the three groups(P>0.05). The VAS scores after 6 h, 8 h, 12 h, 24 h in the observation group were all lower than those before treatment in the same group and lower than those after 6 h, 8 h, 12 h, 24 h in the positive control group and the negative control group(P<0.05). The stress indexes after operation in the observation group were higher than those before operation(P<0.05), but lower than those in the positive control group and the negative control group at the same period(P<0.05). The incidence rates of adverse reactions in the three groups had no statistically significant differences(P>0.05). No patient in observation group took analgesic drugs after operation. The rate of taking analgesic drug in the observation group was lower than in the positive control group and the negative control group(P<0.05). Conclusion Patients using low dose of ketamine combined with lidocaine preemptive analgesia can alleviate postoperative pain and reduce the stress response, but do not increase adverse reactions, so it is worthy of clinical promotion.
引文
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[8]Chan SY,Matthews E,Burnet PW.ON or OFF?:Modulating the N-Methyl-D-Aspartate Receptor in Major Depression[J].Front Mol Neurosci,2017,9:169.doi:10.3389/fnmol.2016.00169.
[9]Tan Y,Wang Q,She Y,et al.Ketamine reduces LPS-induced HMGB1 via activation of the Nrf2/HO-1 pathway and NF-κB suppression[J].J Trauma Acute Care Surg,2015,78(4):784-792.doi:10.1097/TA.0000000000000588.
[10]Shillingburg A,Kanate AS,Hamadani M,et.al.Treatment of severe mucositis pain with oral ketamine mouthwash[J].Support Care Cancer,2017.doi:10.1007/s00520-017-3627-6.
[11]Espahbodi E,Sanatkar M,Sadrossadat H,et al.Ketamine or atropine:which one better prevents oculocardiac reflex during eye surgery?A prospective randomized clinical trial[J].Acta Med Iran,2015,53(3):158-161.
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[13]Zhang JR,Lou W,Yan HH,et al.Effects of lidocaine stress response to tracheal extubation in elderly patients with hypertention after general anesthesia[J].Chin J Gerontol,2015,35(18):5223-5225.[张洁茹,娄望,闫欢欢,等.利多卡因不同给药方式对老年高血压患者全麻拔管应激反应的影响[J].中国老年学杂志,2015,35(18):5223-5225.]doi:10.3969/j.issn.1005-9202.2015.18.088.
[14]Karaca I,Yapca OE,Adiyeke M,et al.Effect of Cervical Lidocaine Gel for Pain Relief in Pipelle Endometrial Sampling[J].Eurasian J Med,2016,48(3):189-191.doi:10.5152/eurasianjmed.2016.0068.
[15]Zeiler GE,Dzikiti BT,Fosgate GT,et al.Anaesthetic,analgesic and cardiorespiratory effects of intramuscular medetomidine-ketamine combination alone or with morphine or tramadol for orchiectomy in cats[J].Vet Anaesth Analg,2014,41(4):411-420.doi:10.1111/vaa.12136.
[2]Xu WJ,Ma J,Xu GP.The analgesia effect and effects on lymphoid immune system of dezocine in different administration time for patients with hysteromyoma[J].Chin JPrimary Med Pharm,2013,20(20):3119-3121.[徐维娟,马军,徐桂萍.地佐辛不同给药时机对子宫肌瘤患者术后镇痛效果及淋巴免疫系统的影响[J].中国基层医药,2013,20(20):3119-3121.]doi:10.3760/cma.j.issn.1008-6706.2013.20.033.
[3]Teixeira RR,Díaz MM,Santos TV,et al.Chronic stress induces a hyporeactivity of the autonomic nervous system in response to acute mental stressor and impairs cognitive performance in business executives[J].PLo S One,2015,10(3):e0119025.doi:10.1371/journal.pone.0119025.
[4]Lu SW,Liu ZQ,Wu L,et al.Effect of dexmedetomidine on the hemodynamics and stress reaction in hypertension patients undergoing gastroscopy[J].J Clin Anesthesiol,2013,29(7):658-660.[卢盛位,刘志群,吴论,等.右美托咪定对高血压患者胃镜检查中血流动力学及应激反应的影响[J].临床麻醉学杂志,2013,29(7):658-660.]
[5]Heesen M,B?hmer J,Brinck EC,et al.Intravenous ketamine during spinal and general anaesthesia for caesarean section:systematic review and meta-analysis[J].ActaAnaesthesiol Scand,2015,59(4):414-426.doi:10.1111/aas.12468.
[6]Lv BL,Lv JF,Guo KQ,et al.Clinical Observation of Lidocaine Combined with Nimodipine in Prevention of Cerebral Vasospasm after Intracranial Aneurysm Operation[J].Prog Mod Biomed,2016,16(21):4124-4127.[吕保来,吕继锋,郭珂清,等.利多卡因联合尼莫地平预防颅内动脉瘤术后脑血管痉挛的临床疗效观察[J].现代生物医学进展,2016,16(21):4124-4127.]doi:10.13241/j.cnki.pmb.2016.21.033.
[7]Khezri MB,Ghasemi J,Mohammadi N.Evaluation of the analgesic effect of ketamine as an additive to intrathecal bupivacaine in patients undergoing cesarean section[J].ActaAnaesthesiol Taiwan,2013,51(4):155-160.doi:10.1016/j.aat.2013.12.004.
[8]Chan SY,Matthews E,Burnet PW.ON or OFF?:Modulating the N-Methyl-D-Aspartate Receptor in Major Depression[J].Front Mol Neurosci,2017,9:169.doi:10.3389/fnmol.2016.00169.
[9]Tan Y,Wang Q,She Y,et al.Ketamine reduces LPS-induced HMGB1 via activation of the Nrf2/HO-1 pathway and NF-κB suppression[J].J Trauma Acute Care Surg,2015,78(4):784-792.doi:10.1097/TA.0000000000000588.
[10]Shillingburg A,Kanate AS,Hamadani M,et.al.Treatment of severe mucositis pain with oral ketamine mouthwash[J].Support Care Cancer,2017.doi:10.1007/s00520-017-3627-6.
[11]Espahbodi E,Sanatkar M,Sadrossadat H,et al.Ketamine or atropine:which one better prevents oculocardiac reflex during eye surgery?A prospective randomized clinical trial[J].Acta Med Iran,2015,53(3):158-161.
[12]Ma W,Cao YY,Qu S,et.al.Remote ischemic preconditioning provides neuroprotection:impact on ketamine-induced neuroapoptosis in the developing rat brain[J].Eur Rev Med Pharmacol Sci,2016,20(23):4972-4979.
[13]Zhang JR,Lou W,Yan HH,et al.Effects of lidocaine stress response to tracheal extubation in elderly patients with hypertention after general anesthesia[J].Chin J Gerontol,2015,35(18):5223-5225.[张洁茹,娄望,闫欢欢,等.利多卡因不同给药方式对老年高血压患者全麻拔管应激反应的影响[J].中国老年学杂志,2015,35(18):5223-5225.]doi:10.3969/j.issn.1005-9202.2015.18.088.
[14]Karaca I,Yapca OE,Adiyeke M,et al.Effect of Cervical Lidocaine Gel for Pain Relief in Pipelle Endometrial Sampling[J].Eurasian J Med,2016,48(3):189-191.doi:10.5152/eurasianjmed.2016.0068.
[15]Zeiler GE,Dzikiti BT,Fosgate GT,et al.Anaesthetic,analgesic and cardiorespiratory effects of intramuscular medetomidine-ketamine combination alone or with morphine or tramadol for orchiectomy in cats[J].Vet Anaesth Analg,2014,41(4):411-420.doi:10.1111/vaa.12136.