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临床医学.docVIP

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临床医学 目录 TOC \o 1-9 \h \z \u 目录 1 正文 1 文1：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临床医学 1 1 资料与方法 3 2 结 果 4 文2：小剂量咪达唑仑用于剖宫产麻醉前用药对母婴的影响 5 1 资料与方法 7 2 结果 8 四组相比P＞ 9 3 讨论 9 参考文摘引言： 10 原创性声明（模板） 12 文章致谢（模板） 12 正文 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临床医学 文1：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临床医学 【Abstract】 Ｏbjective:To explore the preventive analgesia effects of ketamine on postoperative pain in patients undergone laparoscopic cholecystectomy (LC)and whether dexamethasone increase the effects of :Sixty patients undergone LC were randomly divided into three groups(20 patients each group):A group(ketamine group),B group (ketamine plus dexamethasone group),C group(control group).Incision pain and nonincision pain was assessed at 1h,2h,4h,6h,12h and 1d,2d,3d after operation on a visual analogue pain scale(VAS).At the same time,advee effect and analgesic requirements were :Patients in group A and B had lower scores on incision pain and nonincision pain compared with group C (P).No significant differences were found between group A and B on VAS (P).Incidence of postoperative nausea and vomiting significantly decrease in group B compared with group A and C(P).Conclusio:Ketamine combining with dexamethasone significantly improved postoperative analgesia after laparoscopic cholecystectomy and reduced postoperative nausea and ,dexamethasone did not increase effects of ketamine on postoperative pain. 【Key words】 Cholecystectomy,laparoscopic;Ketamine;Dexamethasone;Preventive analgesia 腹腔镜胆囊切除术(laparoscopic cholecystectomy,LC)与传统开腹手术相比,住院时间短,恢复快,术后疼痛轻;但也伴有内脏痛、肩痛、切口痛等,如 治疗 不当则会转为慢性疼痛,有时比开腹手术后疼痛持续时间更长［１］。目前,腹腔镜术后镇痛原则是个体化、多元化治疗,以降低阿片类药用量、促进尽早康复、离院为目标［23］。据研究表明,氯胺酮和地塞米松具有超前镇痛作用,能减少术后阿片类药的用量,适合于腹腔镜术后镇痛,但其作用尚有争议。为此,我们探讨氯胺酮在LC术后超前镇痛作用及地塞米松对氯胺酮超前镇痛的影响,为临床应用提供依据。 1 资料与方法 11 临床资料 选择ASA I～II级择期LC患者60例,其中男37例,女23例;25～60岁。心肺功能正常,无药物依赖、精神疾病、癫痫,无高血压、糖尿病病史。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) １.2 麻醉方法 术前30min肌注阿托品,苯巴比妥钠100mg。入手术室后开放上肢静脉,输注平衡液。全部患者均