摘要
目的探讨嘲手术期多13低剂量氯胺酮输注对乳腺癌手术患者乳房切除术后疼痛综合征（PMPS）的影响。方法选取2015年6月至2016年5月温州医科大学附属义乌医院66例乳腺癌于术患者，采用随机数字表法分为对照组（C组，n=33）和氯胺酮组（K组，n=33）。K组患者术前1d开始每天接受氯眩酮0，5mg／kg稀释至250ml0．9％生理盐水输注1．0h，连续7d，C组患者给予同等剂量0．9％生理盐水。两组患者术中均采用相同的全凭静脉麻醉及气管插管管理（咪唑安定、舒芬太尼、丙泊酚和维库溴铵诱导，丙泊酚、瑞芬太尼维持麻醉）。麻醉苏醒后转至麻醉后恢复事（PACU），观察并给了患者自控静脉镇痛泵（PCIA）。记录人PACU时、术后4h、术后24h及术后2～5d患者疼痛视觉模拟评分（VAS）、镇痛药需求量及术后5d医院焦虑抑郁评分（HADS）。随i方患者6个月并评估患者术后3、6个月时PMPS发牛率、疼痛程度、疼痛部位及HADS。结果K组患者入PACU时、术后4h、术后24h及2～5d疼痛VAS评分分别为（2．5±0．8）、（2．4±0．5）、（2．4±0．5）、（2．0±O．4）、（1．5±0．5）、（1．0±0．4）、1（1）分，均低于C组的（2．9±1．0）、（2．9±0．6）、（2．6±0．5）、（2．3±0．5）、（1．8±0．6）、（1．5±0．5）、l（0）分，差异均有统计学意义（均P〈0．05）；术后各时段所需镇痛药的消耗量亦均低于C组，差异均有统计学意义（均P〈0．05）。随访6个月，C组失访2例，K组失访1例，K组术后3、6个月时PMPS的发生率为25％、22％，均显著低于C组的52％、45％，差异均有统计学意义（X^2=4．729、3．842，均P〈0．05）；两组PMPS患者中，术后3、6个月时VAS〉3分的比例、疼痛部位方面比较差异均无统计学意义（均P〉0．05）；两组患者术前、术后5dHADS评分差异均无统计学意义（均P〉0．05），K组患者术
Objective To investigate the effects of multi-day low dose ketamine infusion for postmastectomy pain syndrome （PMPS） after breast cancer surgeu. Methods This study was a prospective randomized contrnlled trial. From June 2015 to May 2016 in Affiliated Yiwu Hospital of Wenzhou Medical University, 66 patients with breast cancer surgery were ratldomly divided into control group （group C） and ketamine group （ group K）. Patients in group K were infused with 0. 5 mg/kg of ketamine mixed in 250 ml of 0. 9% normal saline in 1 h daily for 7 days. Patients in group C were infused the same dose of 0. 9% normal saline. Anesthesia induction in both groups were given intravenous midaznlam, sufentanil, propofol, vecuronium and intermittent positive p^ssure ventilation after tracheal intubation, anesthesia was maintained with propofol and remifentanil. After awakening, all patients were monitored in postanesthesia care unit （PACU） and given patient-controlled intravenous analgesia（PCIA）. Pain scores were assessed using visual analogue scales （ VAS ） during PACU, 4 h, 24 h and 2 - 5 d after surgery, simultaneously analgesic requirement were recorded. Patients were evaluated Hospital Anxiety and Depression Scale （HADS） 5 d after surgery. The patients were followed up for 6 months. At 3 m, 6 m after surgery, the incidence of PMPS, the level of pain, pain site and HADS scale were assessed. Results The VAS score uring PACU, 4 h,24 h and2-5 d after surgery in group K（ （2.5 ±0.8）, （2.4 ±0.5）, （2.4±0.5）,（2.0±0.4）, （ 1.5±0. 5 ）, （ 1.0±0. 4）, 1 （ 1 ）, respectively） was lower than those in group C （ （2. 9 ±1.0）, （2. 9 ±0. 6）, （2. 6±0. 5 ）, （2. 3±0. 5 ）, （ 1.8±0. 6）, （ 1.5 ±0. 5 ）, 1 （ 0 ）, respectively）. There was statistically difference between the two groups （ all P 〈 0. 05 ）. The consumption of analgesics required at each time postoperation in group K were also lower than that of group C （ all P 〈 0. 05 ）. Followed up ior
出处
《中华医学杂志》
CAS
CSCD
北大核心
2017年第46期3636-3641,共6页
National Medical Journal of China
关键词
疼痛
手术后
氯胺酮
剂量效应关系
药物
乳腺肿瘤
外科手术
Pain, postoperative
Ketamine
Dose-response relationship, drag
Breastneoplasms
Surgical procedures, operative
