艾司氯胺酮在妇产科病人中的临床应用进展
Progress in Clinical Application of Esketamine in Gynecological Patients
DOI: 10.12677/ACM.2023.132217, PDF,   
作者: 余凤仙, 李晓霞*:重庆医科大学附属第二医院麻醉科,重庆
关键词: 艾司氯胺酮妇产科麻醉临床应用Esketamine Obstetrics and Gynecology Anesthesia Clinical Application
摘要: 氯胺酮是20世纪合成的唯一具有镇痛作用的静脉麻醉药物,但因众多的不良反应限制了其临床应用。艾司氯胺酮是氯胺酮的纯右旋异构体,与氯胺酮相比,具有效价高、受体亲和力强、心血管和精神方面不良反应小等特点。本文就艾司氯胺酮妇产科领域的临床应用研究进展作一综述。
Abstract: Ketamine is the only intravenous anesthetic with analgesic effect synthesized in the 20th century, but its clinical application is limited due to numerous adverse reactions. Esmolamine is a pure dex-trose isomer of ketamine and is characterized by high potency, strong receptor affinity, and less cardiovascular and psychiatric adverse effects compared with ketamine. This article reviews the research progress of clinical application of esketamine in obstetrics and gynecology.
文章引用:余凤仙, 李晓霞. 艾司氯胺酮在妇产科病人中的临床应用进展[J]. 临床医学进展, 2023, 13(2): 1574-1580. https://doi.org/10.12677/ACM.2023.132217

参考文献

[1] Hirota, K. and Lambert, D.G. (2022) Ketamine; History and Role in Anesthetic Pharmacology. Neuropharmacology, 216, Article ID: 109171. [Google Scholar] [CrossRef] [PubMed]
[2] Domino, E.F. and Warner, D.S. (2010) Taming the Ketamine Tiger. The Journal of the American Society of Anesthesiologists, 113, 678-684. [Google Scholar] [CrossRef
[3] Zanos, P., Moaddel, R., Morris, P. J., et al. (2018) Ketamine and Ketamine Metabolite Pharmacology: Insights into Therapeutic Mechanisms. Pharmacological Reviews, 70, 621-660. [Google Scholar] [CrossRef] [PubMed]
[4] Dong, T.T., Mellin-Olsen, J. and Gelb, A.W. (2015) Ketamine: A Growing Global Health-Care Need. British Journal of Anaesthesia, 115, 491-493. [Google Scholar] [CrossRef] [PubMed]
[5] Wolff, K. and Winstock, A.R. (2006) Ketamine. CNS Drugs, 20, 199-218. [Google Scholar] [CrossRef] [PubMed]
[6] Sinner, B. and Graf, B.M. (2008) Ketamine. In: Schüttler, J. and Schwilden, H., Eds., Modern Anesthetics. Handbook of Experimental Pharmacology, Vol. 182, Springer, Berlin, 313-333. [Google Scholar] [CrossRef] [PubMed]
[7] Hustveit, O., Maurset, A. and Øye, I. (1995) Interac-tion of the Chiral Forms of Ketamine with Opioid, Phencyclidine, σ and Muscarinic Receptors. Pharmacology & Toxi-cology, 77, 355-359. [Google Scholar] [CrossRef] [PubMed]
[8] Maudlin, B., Gibson, S.B. and Aggarwal, A. (2022) Long Term Safety and Efficacy of Sub-Lingual Ketamine Troches/Lozenges in Chronic Non-Malignant Pain Manage-ment. Internal Medicine Journal, 52, 1538-1543. [Google Scholar] [CrossRef] [PubMed]
[9] Tumukunde, J., Lomangisi, D.D., Davidson, O., et al. (2015) Effects of Propofol versus Thiopental on Apgar Scores in Newborns and Peri-Operative Outcomes of Women Undergoing Emer-gency Cesarean Section: A Randomized Clinical Trial. BMC Anesthesiology, 15, Article No. 63. [Google Scholar] [CrossRef] [PubMed]
[10] 张瑾, 陈亮, 姚淑萍, 高金贵. 《中国产科麻醉专家共识(2017)》解读[J]. 河北医科大学学报, 2019, 40(2): 128-132.
[11] 郑小虎, 杨红军, 占翔. 小剂量艾司氯胺酮复合丙泊酚对剖宫产全麻的效果及对新生儿的影响[J]. 深圳中西医结合杂志, 2022, 32(1): 104-107.
[12] 姚罡. 艾司氯胺酮诱导全身麻醉剖宫产术新生儿Apgar评分影响: 一项倾向性评分分析[J]. 实用妇科内分泌电子杂志, 2020, 7(22): 53-54.
[13] 徐敏杰. 艾司氯胺酮在产科紧急剖宫产中的应用研究[J]. 黑龙江医药, 2021, 34(4): 879-881.
[14] 赵希丽, 李秒, 马琛琛. 二胎政策实施后剖宫产率的变化及其影响因素分析[J]. 海南医学, 2020, 31(9): 1137-1140.
[15] 朱俊峰, 顾国华. 小剂量氯胺酮用于剖宫产手术的临床观察[J]. 中国实用医刊, 2011, 38(6): 41-42.
[16] 常俊晓. 艾司氯胺酮复合硬膜外麻醉用于剖宫产术的临床效果研究[J]. 母婴世界, 2021(14): 18, 20.
[17] 杨梅, 卞新荣. 艾斯氯胺酮对剖宫产产妇术后镇痛效果及呼吸循环功能的影响[J]. 齐齐哈尔医学院学报, 2021, 42(10): 856-859.
[18] Suppa, E., Valente, A., Catarci, S., Zanfini, B.A. and Draisci, G. (2012) A Study of Low-Dose S-Ketamine Infusion as “Preventive” Pain Treatment for Cesarean Section with Spinal Anesthesia: Benefits and Side Effects. Minerva Anestesiologica, 78, 774-781.
[19] Acosta, A., Gomar, C., et al. (2006) Ultrastructure of Ca-nine Meninges after Repeated Epidural Injection of S(+)-Ke- tamine. Regional Anesthesia & Pain Medicine, 31, 438-444. [Google Scholar] [CrossRef] [PubMed]
[20] Feltracco, P., Barbieri, S., Rizzi, S., et al. (2013) Perioperative Analgesic Efficacy and Plasma Concentrations of S(+)- Ketamine in Continuous Epidural Infusion during Thoracic Sur-gery. Anesthesia & Analgesia, 116, 1371-1375. [Google Scholar] [CrossRef
[21] Himmelseher, S., Ziegler-Pithamitsis, D., Argiriadou, H., et al. (2001) Small-Dose S(+)-Ketamine Reduces Postoperative Pain When Applied with Ropivacaine in Epidural Anesthe-sia for Total Knee Arthroplasty. Anesthesia & Analgesia, 92, 1290-1295. [Google Scholar] [CrossRef] [PubMed]
[22] 李长辉. 氯胺酮硬膜外给药在剖宫产术中的应用[J]. 中国医药指南, 2011, 9(23): 257-258.
[23] Unlugenc, H., Ozalevli, M., Gunes, Y., Olguner, S., Evrüke, C., Ozcengiz, D. and Akman, H. (2006) A Double-Blind Comparison of Intrathecal S(+) Ketamine and Fentanyl Combined with Bupi-vacaine 0.5% for Caesarean Delivery. European Journal of Anaesthesiology, 23, 1018-1024. [Google Scholar] [CrossRef
[24] 郭彬. 硬膜外氯胺酮布比卡因合剂用于剖宫产术的临床观察[J]. 医学理论与实践, 2008, 21(11): 1357.
[25] 黄俊, 蒋来, 唐朝亮. 艾司氯胺酮应用于重度子痫前期合并心衰孕妇剖宫产1例的报告[J]. 安徽卫生职业技术学院学报, 2021, 20(3): 138-139.
[26] 丁桂芝. 局部浸润麻醉加氯胺酮复合芬太尼在剖宫产中的应用[J]. 河北医学, 2010, 16(4): 461-463.
[27] 殷霞丽, 董媛媛. 艾司氯胺酮用于遗传性大疱性表皮松解症产妇剖宫产的麻醉管理一例[J]. 临床麻醉学杂志, 2022, 38(3): 331-332.
[28] 孙山苏, 徐志新. 右旋氯胺酮的临床应用研究进展[J]. 海南医学, 2021, 32(19): 2565-2568.
[29] 陆雷. 小剂量艾司氯胺酮复合右美托咪定在妇科腹腔镜手术中的应用[J]. 现代养生, 2022, 22(15): 1260-1263.
[30] 戴珩, 颜娅, 李有长. 曲马多、舒芬太尼分别与丙泊酚联合在宫腔镜手术静脉麻醉诱导中的应用效果对比观察[J]. 山东医药, 2018, 58(19): 59-61.
[31] 程英莉, 应礼, 卢银军, 吴敏慧. 艾司氯胺酮复合丙泊酚在早期人工流产中的应用[J]. 全科医学临床与教育, 2022, 20(5): 405-409.
[32] 童江荣, 李晓晖, 杜大春. 舒芬太尼与艾司氯胺酮分别复合丙泊酚用于妇科宫腔镜手术麻醉效果比较[J]. 名医, 2022(1): 168-170.
[33] 高长胜, 黄符香, 李永乐. 艾司氯胺酮静注在人工流产术中的应用效果观察[J]. 山东医药, 2022, 62(11): 56-58.
[34] 钱夏丽, 夏凡, 沈晓凤, 徐世琴. 艾司氯胺酮复合丙泊酚在宫腔镜检查术中的应用[J]. 临床麻醉学杂志, 2021, 37(7): 706-708.
[35] 秦春雨, 封学伟, 王程荣, 冯欣. 阿片类药物对剖宫产术后镇痛的效果及安全性[J]. 临床药物治疗杂志, 2020, 18(11): 67-71.
[36] 盛飞凤, 陈莉婧, 杜敏群, 方瑞. 艾司氯胺酮对剖宫产术后镇痛效果和产后抑郁的影响以及不良反应分析[J]. 今日药学, 2022, 32(2): 150-152.
[37] 林贵文, 胡青林, 杨志来. 艾司氯胺酮复合布托啡诺对剖宫产术后镇痛效果及产后状态的影响[J]. 中国计划生育学杂志, 2022, 30(5): 1050-1054.
[38] 李惠萍, 韦成全, 莫玉兰, 熊云新, 吴钢, 莫宁, 裴世成, 戴体俊. 氯胺酮的镇痛作用与脊髓NMDA受体的关系[J]. 解放军药学学报, 2007, 23(4): 267-269.
[39] 李惠萍, 吴钢, 韦成全, 莫玉兰, 裴世成, 戴体俊. 氯胺酮镇痛作用与3种受体的关系[J]. 解放军医学杂志, 2007(10): 1048-1050+1074.
[40] 马树勇, 赵永忠. 罗哌卡因复合氯胺酮在硬膜外无痛分娩中的应用研究[J]. 中国社区医师医学专业, 2012, 14(1): 144-145.
[41] 黄子娟, 王志萍, 梁宵. 艾司氯胺酮联合盐酸罗哌卡因对分娩镇痛及产后抑郁的影响[J]. 中南医学科学杂志, 2021, 49(6): 655-658.
[42] Irnaten, M., Wang, J., Chang, K.S., Andresen, M.C. and Mendelowitz, D. (2002) Ketamine Inhibits Sodium Currents in Identified Cardiac Par-asympathetic Neurons in Nucleus Ambiguus. Anesthesiology, 96, 659-666. [Google Scholar] [CrossRef] [PubMed]
[43] Kamp, J., van Velzen, M., Aarts, L., Niesters, M., Da-han, A. and Olofsen, E. (2021) Stereoselective Ketamine Effect on Cardiac Output: A Population Pharmacokinet-ic/Pharmacodynamicmodelling Study in Healthy Volunteers. British Journal of Anaesthesia, 127, 23-31. [Google Scholar] [CrossRef] [PubMed]
[44] Hashimoto, K., Kakiuchi, T., Ohba, H., Nishiyama, S. and Tsukada, H. (2017) Reduction of dopamine D2/3 Receptor Binding in the Striatum after a Single Administration of Esketamine, but Not R-Ketamine: A PET Study in Conscious Monkeys. European Archives of Psychiatry and Clinical Neuroscience, 267, 173-176. [Google Scholar] [CrossRef] [PubMed]
[45] Morrison, R.L., Fedgchin, M., Singh, J., et al. (2018) Effect of Intranasal Esketamine on Cognitive Functioning in Healthy Participants: A Randomized, Double-Blind, Place-bo-Controlled Study. Psychopharmacology, 235, 1107-1119. [Google Scholar] [CrossRef] [PubMed]
[46] Yan, J., Li, Y.-R., Zhang, Y., Lu, Y. and Jiang, H. (2014) Re-peated Exposure to Anesthetic Ketamine Can Negatively Impact Neurodevelopment in Infants. Journal of Child Neurol-ogy, 29, 1333-1338. [Google Scholar] [CrossRef] [PubMed]