烧伤后慢性疼痛病理机制及艾司氯胺酮镇痛策略的研究进展

摘要/Abstract

摘要：

烧伤后慢性疼痛是一种常见且难治的并发症，其发生涉及神经损伤、中枢敏化和神经炎症等多重机制，病理生理基础主要包括外周神经纤维异常再生、背根神经节表观遗传重编程、脊髓胶质细胞激活和促炎信号通路介导的神经元超兴奋性。艾司氯胺酮作为N-甲基-D-天冬氨酸（NMDA）受体拮抗剂，可通过抑制谷氨酸能信号、调节突触可塑性和拮抗神经炎症等多途径发挥镇痛作用。该药物可有效缓解烧伤患者急性和慢性疼痛，减少阿片类药物用量，并改善其情绪与认知功能。现对艾司氯胺酮在烧伤后慢性疼痛中的作用机制、临床疗效和用药策略进行综述，从烧伤严重程度、部位和年龄等维度提出分层镇痛策略，总结其短期和长期安全性及不良反应，以期为艾司氯胺酮在烧伤后慢性疼痛管理中的精准应用提供理论依据及临床参考。

关键词: 艾司氯胺酮, 烧伤, 疼痛, N-甲基-D-天冬氨酸受体拮抗剂, 术后疼痛, 疼痛管理

Abstract:

Burn injury-induced chronic pain is a common and refractory complication， of which the pathogenesis involves multifaceted mechanisms including neuropathic damage， central sensitization， and neuroinflammation. The underlying pathophysiology primarily consists of abnormal peripheral nerve regeneration， epigenetic reprogramming in the dorsal root ganglion， activation of spinal glial cells， and neuronal hyperexcitability mediated by pro-inflammatory signaling pathways. As the N-methyl-D-aspartate （NMDA） receptor antagonist， esketamine exerts analgesic effects through various pathways such as inhibiting glutamatergic signaling， modulating synaptic plasticity， and attenuating neuroinflammation. Esketamine may effectively alleviate acute and chronic pain in burn patients， reduce opioid consumption， and improve their mood and cognitive functions. This review summarizes the mechanism， clinical efficacy， and medication strategies of esketamine for burn injury-induced chronic pain. It also proposes stratified analgesia strategies based on burn severity， location， and patient age. The short-term and long-term safety profiles， as well as adverse effects associated with esketamine， are discussed， aiming to provide theoretical foundation and clinical reference for the precise application of esketamine in the management of burn injury-induced chronic pain.

Key words: Esketamine, Burn, Pain, N-methyl-D-aspartic acid receptor antagonist, Postoperative pain, Pain management

中图分类号:

R614.2

陈鑫旭,陈胜春,冯春生,朴美花. 烧伤后慢性疼痛病理机制及艾司氯胺酮镇痛策略的研究进展[J]. 吉林大学学报(医学版), 2025, (): 1-11.

Xinxu CHEN,Shengchun CHEN,Chunsheng FENG,Meihua PIAO. Research progress in pathology mechanism of burn injury-induced chronic pain and analgesic strategy with esketamine[J]. Journal of Jilin University(Medicine Edition), 2025, (): 1-11.

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