小剂量氯胺酮用于术后镇痛的研究及其临床价值

被引:147
作者
刘国凯
黄宇光
罗爱伦
机构
[1] 中国医学科学院中国协和医科大学北京协和医院麻醉科
关键词
小剂量氯胺酮; 副作用; 术后疼痛; 硬膜外; 阿片类药物;
D O I
暂无
中图分类号
R614 [麻醉学];
学科分类号
100217 ;
摘要
<正> N-甲基-D-天冬氨酸受体(NMDA受体)的发现和它对疼痛过程及脊髓神经元可塑性变化的影响重新引起人们对氯胺酮(NMDA受体拮抗剂)作为潜在抗痛觉过敏药物的兴趣。现已清楚大剂量氯胺酮作为麻醉药物和小剂量作为镇痛药物或抗痛觉过敏作用之间的区别,小剂量氯胺酮其本身不产生镇痛作用,但是与阿片类药物联合应用时可减少阿片的用量,并比单独用药镇痛效果更好。 本文总结了术后疼痛治疗中小剂量氯胺酮的不同给药方式的应用情况;并探讨了小剂量氯胺酮的副作用和未来研究的方向。小剂量氯胺酮的定义为一次肌注小于2 mg/kg,或者经静脉或硬膜外小于1 mg/kg,或者经静脉持续输注≤20μg·kg-1·min-1。
引用
收藏
页码:78 / 80
页数:3
相关论文
共 18 条
[11]  
Mechanisms of hyperalgesia and morphine tolerance: a current view of their possible interactions. Mao J,Price DD,Mayer DJ. Pain . 1995
[12]  
Lack of effect of intrathecally administered N-methyl-D-aspartate receptor antagonists in a rat model for postoperative pain. Zahn PK,Brenan TJ. Anesthesiology . 1998
[13]  
Mapping of punctuate hyperalgesia around a surgical incision demonstrates that ketamine is a powerful suppressor of central sensitization to pain following surgery. Stubhaug A,Breivik H,Eide PK,et al. Acta Anaesthesiologica . 1997
[14]  
Postoperative analgesic requirement after cesarean section : a comparison of anesthetic induction with ketamine or thiopental. Ngan Kee WD,Khaw KS,Ma ML,et al. Anesthesia and Analgesia . 1997
[15]  
Concomitant administration of morphine and an N-methyl-D-aspartate receptor antagonist profoundly reduces inflammatory evoked spinal c-Fos expression. Honore P,Chapman V,Buritova J,et al. Anesthesiology . 1996
[16]  
Comparison of ketamine and morphine for analgesia after tonsillectomy in children. Marcus RJ,Victoria BA,Rushman SC. British Journal of Anaesthesia . 2000
[17]  
Ketamine blocks currents through mammalian nicotinic acetylcholine receptor channels by interaction with both the open and the closed state. Scheller M,Bufler J,Hertle I,et al. Anesthesia and Analgesia . 1996
[18]  
Ketamine enhances local anesthetic and analgesic effects of bupivacaine by peripheral mechanism: a study in postoperative-patients. Tverskoy M,Oren M,Vaskovich M,et al. Neuroscience Letters . 1996