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ĐẶT VẤN ĐỀ

 !"#$%&'()*+,
&-./)0 12$$3*4
5&677489:$;'<=&+$=
5$>6?$@,&-.A/)
BCDBED'
F+$"1@?&4G$H
-&$I+-66''F+$*
42=>">)*I+-"J%6$!A4G
24K$!?&"2$LM'<*$=+
$"1@L&7N6?$52$H=86?O
 2P$!+$+$6=Q
*$GP$6BRDBSDBTDBRD'
<*$=,>=4K,&+!/)
*$U>-*$GP$67&= *$V=?N'
W4/*$==4K+X7I$?Y$$&)
/$$=7&Z"5$+&[W\]$$&Y$
$747$&U+,&$-P^K,
6,_$&'`&H,K,*$="1
*_$&6$&=5*$=+$'a$^4/
=? 464K=5$A 4 4/*$=
&,4=5*$=+$BRDBbDBCRD'c&,V7;
*$=&4GK=$-=Q[IZ
]'a"7;$&?&"d&7
C
4K726.7"1$&$,'e6
4K.=+7;$& )=>+Z& %%&
`ce\"4/'
f%$,$72 7*$=&$6

1.2. SINH LÝ ĐAU SAU MỔ
1.2.1. Định nghĩa
a%&Q-,=),>[p\q lSb]=$Q
*$Q6?)6LO*$7&4/=I&
?$$16Q6&$-=QrA
4/2'a&= =$V+$=L2+
6I6GskBCD'
1.2.2. Đường dẫn truyền cảm giác đau'
 W*$==4K7?s&6Ji&1)
,>&"[L%$9'C]0
Hình 1.2. Sơ đồ dẫn truyền cảm giác đau
j
1.2.2.1. Đường dẫn truyền từ các receptor vào tủy sống
F7&?44/$1>$
&t/uW=&"VV/_
_& _=Q%%&*$==Z7&A
>&"=4K,Q1A76$1
&4$L4/=Q$$"$i& BCD'W
%%&*$*$=26$V'W%%&"1
 "*.V4K"N"VVN& 
$48=*$4Kv.*$=w
[%%+]64Kv7 w[x73]'F4K>
&"7?*$=s+s+A+,
*$"N"VV+y*$=/4BCjDBCSDBkD'`+
$6>$L*$Q&=6?57N4L2
*-6$[2&+7zu]%%&N"V
V+-.BCDBCDBlD'
W*$==4K?s%%&*$=6?>&
"-2+s+A+,%&+K\
δ

24G=QGL2$=-O•=&'
1.2.3. Những yếu tố ảnh hưởng tới đau sau mổ
1.2.3.1. Ảnh hưởng của phẫu thuật
3€&>,)>=N=+$'aG6$-
=Q=Q2?6&&4I
Z,=?2>%&
6;6Q+,BCDBCDBCTD'
3F"V6&++IZ67@7Q
2'W"6", 5=.7&+Z&/'
`4K1V=/'
3mNV$66G•*4=+
$'W=4Gd&=?/=4G‚)"y
+4G=/)=4G4L4/-'
3F?2sG-k=>G-b+$6=2
=*$7-6=V/s-k+$'
S
1.2.3.2. Các ảnh hưởng khác
3f=4K*V6•N,4$"*.N=A
+y,/'
3e;,*$=?&/&$9+$
4G=V/6"1=&R3bG=+$'
3F41ƒ7&4$4=4
>V6&+'''4>&=5=8=97,6*$="5
4K,*$=+$'
3W1.$+ +$'
34/*$=+$'
1.3. ĐAU SAU PHẪU THUẬT Ổ BỤNG
1.3.1. Nguyên nhân
1.3.1. 1. Đau nguồn gốc từ thành bụng
3F4G$&4G7t?

F$*$=Q77Q"d&7G$^77'
1.3.2.4. Tiết niệu
<V='
T
1.3.2.5. Thần kinh nội tiết
F=-6=*"V$.%&$&+&
&&$&.4[<(]6+&%++7&+%&6+
.=4G$.@$,4& …&%65:$
;BbED'
1.3.2.6. Tâm thần
F&t+Ki$2A$*$'
†94/$1&"d&-t-"VV
%%&;"'W%%&N"VV$* 
^2&_A)96$62"VV&
*$=4K* &,7&"VV'F
-6"VV=$-,==&+$6
@*4/)'<*$=+$"1=A
6{&=*"V"1N->+y=
5$&1277QQ>$:7N
"4/'a2*@=7=>.U>-+
$BCTD'
1.3.3. Các phương pháp giảm đau sau mổ bụng
1.3.3.1. Gây tê vùng để giảm đau
3a&$-t4=4/*$=)*
+$'
3<*$=&$-=&t4=4/*$
=)*4 4K=5$" ".6?"‡=%%&
$-BkSDBEbD'

34/*$=7&Z"5$+&=4G&

$6'
‰`%…&$6$7&=4K+X7_$
67&.+,$'
‰f%$?26%=4K">&+X7'(
?-6?"%$">K6,*$="09$?
6G=5$+X7=5 )*,2BRDBjED'
<*$=+$4G=4K7747=4/
--">K?,64/=5=)**$=
=IG*$7"1$&$,A$^4/$^,
BkbDBRkD'
1.3.4. Các phương pháp đánh giá đau sau mổ
1.3.4.1. Phương pháp khách quan 
3F&+Z=ƒ+,+ $4I=Q&$&
[%&$&+&u]'F4/,"d$">)*"1V
L69 ?>,*4">)*BCRD'
k
3F&+Z=ƒ124"V$5Vt+-
&=[Œzm]44K=ƒ[zŒ•]5V"V41
[m]5VV6&"V[%6%+&$%]'
3aV4K,*$=[$&&L&7&,u]$
=i7;),*$=W\Wz\BCbD'
1.3.4.2. Phương pháp chủ quan
Ža=5$=9=I7[m+\&q%3m\q]
a4=&=Q=$Q4 $7CT$'c)6?
V 94K5N$-=Q==57:
7+&+'c=,7)6?V, T6
=+,sT=>T'n=4K=N&J44/
-6$-=Q=A$9'f&*s=5$T=>6NV&J
ƒ=5$=m\q[$)6?V,]'a4
Ai\+3•%%BCDBCkDBClD'

aUI=Q$&&i&6>4/{T$&">
K"d$6&%i&7:2$)&$i&AM%$2
M=M&67:2$)&'
c&5 A>ST„2"1&V
ET3ST„=&*)45H*)$6'b3T„
=4K*747"15&'
j
1.4.3. Dược lực học
1.4.3.1. Trên thần kinh trung ương
c&->afag*$=->12IA6
$Q+,=6?=i&'c&"VVafag-/I
16"*.&&4BjD'
3a7*$=0$& 7*$=$6=N
Q6&?4K+X7 72*&='
3a7"0&["=N=]&
"VV&t'
3a70$&$=+Z
"111$2 56?Q
$6?"VV=$$7;=i7;?4K$A
$&'
3a79*$0$&4G+*"&="#$6
->LO*$$4=1"" N6*$
)$&t$+*'
3c&$*$=-A6;(&$+6"V
V*$.>&$&"6*$4K4
5'c&.*+Z* \Wa(6&$&>'
1.4.3.1. Tác dụng trên hô hấp
3•>120$&$*$=-A$12
A6>ŠC6.WŠ
C

1.4.4. Tương tác thuốc
3m,A0$.+12.+Z$7N67:A/'
3m,0.7*$=./i$
7:>'
3m,U&*$7:>'
3m,$0$./+12'
1.4.5. Quen thuốc
†%,Q6&?7;6+Z7;'`4G)%
, 57;$&6?2T3CT?=6&/
?+&64G94G'(4K =4K*V 7&
%"%6*$&"VV%%&->* $Q+,2
&_->7%+%$*$+*L2\c6H'
f7;,=/5*-P.\c6H69
6?$&+=HJ./4=5%%&=-$4
•BRD'`&+Z&&%%&“A,*$=_$&
$."d&7)*A$6NV%%&`ce\'f%$-
>%%&`ce\*$4K)%,A,_$&
BblDBSkD'
1.5. DƯỢC LÝ KETAMIN
f%$,$Y$"1* 7t'
a,$Y$72 V2*$=BbD=i=4K+X7
Qi&?.$=4=5'a,=4K
K.$lbC7&1"%3e6+[W6q%6%+]=4K=46&
N4Gs.$lET6+X7&>m`$'
S
1.5.1. Tính chất lý học
f%$$QX 2O76H7L2A%7
6 &"1=,L-'`  7=I)_q[‰]6•
[3]3"%$&4fEj_4KXCkS6I74
7$,5'a$+"%$=4K9747$,

*C3kG4G'
f%$=4K*s)45lT„7475 R„
747"15 k„*s)'
f$Y$GG774kT7,=
+O"d&7j3jO'
1.5.3. Dược lực học
W/>7A"%$2-)=>?,
+_)&"1)%%&0
3a7%%&“δ˜A,_$&)=>
4K7,_$&'
3a7%%&&%'
3a7%%&A$&&$%"%$&&
,->=L,$&&$%[$&&$%7%+%7&
++%$][%"&%6q$lSC]=,V&=?ƒ)
9*$='
CT
3a=Q=,""1%%&`ce\27
?"VV")=>4K.=6
-'
1.5.3.1. Tác động lên thần kinh trung ương
a;Q6&?4K"%$9v$w7&
$Q$,->&=QA6Ji&66;74=I&"
"VV6?64'a$+/6&.
4/Z/*$=4A15$t$=IXi
i'*L$*L)**L,
6H'n 5&.>4_*4$t'q$
)>+Z"L*&$4$Q+,4GK
*&BbD'
™&L*"7;?&"$7;?
@'W 54KP&?$%—&7—%

f%$1)->%%&`ce\"1ƒ$*$
4K.=-7&4/$1$H$*$4K7
A,*$=_$&BjbDBETDBESD'
*-6$L*+)924/6>
5A:$;'a>%&+4/$1/5,P
"=Q$Q&*-$:7N67=>*-6$
6$=V79+ZP=N=5?+r&'a&*-6$6
HA2?6$[&3…$$&%]2)_'*-6$
+ZP@2"6$62,6$'f%$2&
+$7:>P'f%$*$$6+*L2
CC
&"?6$[&"%&3…$$&%]P6*$22
&)9+&dBCSD'
1.6. Nghiên cứu tác dụng giảm đau của ketamin
f%$?2/?$ 7*$="d$$&'
m&=QA"%$1)%%&`ce\$$
VG+Z66HA"%$$+'f%$=4K7;$
,*$ =^K$&'fVV=$&&%%&
`ce\4K."VVA>&"+s+U
+,$.*$4/4K7 6
*$='f%$$Q2=,""1A%%&
`ce\ 5.s4K*$4/"V
V=&•4.*4K7 BblD'qZ&
&%%&“A,*$=_$&$."d&7)*
A$6NV%%&`ce\'fƒ7;,*$=_
$&?&"d&7+y4K7=? 57
=>.=+$BbkD'f%$1)->%%&`ce\ 5
Hs+Z5A4K7'f$/
+&?-6?"%$4,^K$&&*$
==4/-BCjD'`I=Q>4/)*=5 7

3\7$6Q+Z[CTTj]-RT",
&Q=4K=%%&>"=;6?Tk
${"&6TEj„4$679T${"{G&6TC„
&RSG"&&'W=4KC
CR
 $'` $"%$=4K$Y$"%$Tj${"I=4K
?k${"{O&$6j${"{O&RSG>
%&'` $-=4K?4$,+!'f>)* $"%$
V$&/2,=>lT
T
/ $-BbD'
3•"%6Q+Z[CTTS]-7*$=A"%$
S=4K$k $'` $p
"%$Y$Tj$+"$IC${"{O&RSG'
` $pp;? $p4s"%$O">OQ$'
` $ppp=4K?4$,+!'f>)*24K$&
&CRG=2/ !Y," $p+&6 $pp6
ppp=5$=m\q2/ $ppp+&6 $pppU1 $ppp
&/ $p=5$"1"@ $"1
&N9=1*&BSkD'
<=[.$CTTS]$Q+,-&$"%$6&$&
=5*$=+$)W\'f>)**$4K$&>
=Q=N6"1.7"1$&$,BbDBbkDBERD'
W&=>4 -&+&+7;;?
"%$,&?&++= ?4G
=5$476+"6?HI+-'
1.8. Một số khái niệm và định nghĩa
3<*$=7ZH[%%$6%%+]+X7,s4
O7.*4K*$4/4/
7&64/7&6$&G$6=&=+