摘要
术后疼痛常引起一系列不良的生理应激反应,延迟术后康复。良好的术后疼痛管理是加速康复外科的重要环节。临床常用的术后镇痛药物有阿片类药物、非甾体抗炎药(nonsteroid anti-inflammatory drug, NSAID)/对乙酰氨基酚、氯胺酮、右美托咪定等。文章描述了以上药物各自的特点、副作用、用法用量以及应用现状。阿片类药物是最常用的全身镇痛药物,但需关注其副作用(尤其是大剂量使用时)。NSAID和对乙酰氨基酚是多模式镇痛中最常用的非阿片药物,临床使用时需注意其禁忌证和潜在危害。围手术期使用氯胺酮可改善术后镇痛效果,但大剂量使用容易产生精神症状。右美托咪定与阿片类药物复合用于自控静脉镇痛可改善镇痛效果,右美托咪定用作局麻药佐剂可延长外周神经阻滞的时间,但需注意其镇静和循环副作用。合理联合使用上述药物,有望进一步降低药物相关副作用,提供满意的术后镇痛效果,并减少术后并发症的发生。不同药物镇痛对围手术期和远期预后的影响仍需要进一步临床研究。
Postoperative pain frequently causes adverse physiological stress responses and delays postoperative recovery.Effective analgesia management is the guarantee of rapid recovery following surgery.Medications commonly used for postoperative analgesia include opioids,nonsteroid anti-inflammatory drug(NSAID)/acetaminophen,ketamine,and dexmedetomidine.The characteristics of the above drugs,the adverse effects of postoperative analgesics,dosages,and administration of postoperative analgesics,and the current status of the above drug applications were described in this review.Opioids are the most commonly used systemic analgesic agents;however,care should be taken on their side effects,especially when administered in high doses.NSAID and acetaminophen are the most commonly used non-opioid analgesics in multimodal analgesia;attention should be given to their contraindications and potential risks.Perioperative use of ketamine enhances postoperative analgesia but may cause psychiatric symptoms at high doses.Dexmedetomidine improves analgesia when used in combination with opioids and extends peripheral nerve block duration when used as a local anesthetic adjuvant;the side effects include sedation,hypotension,and bradycardia.A rational combination of the above medications is expected to provide satisfactory postoperative analgesia while reducing drug-related side effects.Further clinical research should focus on the impacts of various analgesics on perioperative and long-term outcomes.
作者
莫小倩
苏仙
王东信
Mo Xiaoqian;Su Xian;Wang Dongxin(Department of Anesthesiology,Peking University First Hospital,Beijing 100034,China)
出处
《国际麻醉学与复苏杂志》
CAS
2022年第6期647-653,共7页
International Journal of Anesthesiology and Resuscitation
基金
国家重点研发项目(2018YFC2001800)。
