摘要
目的 研究术后吗啡病人自控静脉镇痛（PCIA）中加用小剂量的纳洛酮对镇痛效果、吗啡用药量及其不良反应的影响.方法 选择ASA Ⅰ或Ⅱ级下肢骨科手术92例，在所有入选病人中，有3例结果显示可疑而退出.所有病人都在L2～3腰-硬联合麻醉下进行手术，术后立即开始PCIA.依用药方案不同随机分为三组：Ⅰ组（29例），吗啡复合纳洛酮1组，两药浓度比为1 600：1；Ⅱ组（32例），吗啡复合纳洛酮2组，浓度比为2 000：1；Ⅲ组（28例），单纯吗啡作为对照.各组静脉泵中的吗啡浓度相同为100 ml生理盐水中加入80 mg吗啡.镇痛泵的设定参数为：PCA量为2 ml，锁定时间为8 min，无背景剂量.记录术前病人的年龄、身高、体重等一般情况，记录启动PCA泵前后病人的SpO2，术后2、6、24 h病人的疼痛视觉模拟评分（VAS）、吗啡的消耗量及恶心、呕吐、瘙痒等不良反应和各处理药物的用量.结果 根据实际进入的89例研究结果显示各组无论在吗啡的消耗量还是在术后不良反应的发生率上差异都无统计学意义，Ⅰ组、Ⅱ组和Ⅲ组术后恶心发生率分别为58.6%、65.6%和64.2%，呕吐的发生率分别为31.1%、34.3%和35.7%，瘙痒的发生率分别为41.3%、40.6%和42.8%，另外各组需要应用补救药物的例数差异也无统计学意义.结论 在术后吗啡PCIA治疗药液中加入小剂量纳洛酮对减少吗啡消耗量，降低恶心、呕吐的发生率无明显效果.
Objective To compare the analgesic effect and side effects of morphine for patientcontrolled intravenous analgesia （PCIA） with or without small dose naloxone after lower limb surgery. Methods In this randomized double-blind study,92 ASA class Ⅰ or Ⅱ patients underwent lower limb surgery were allocated to one of three groups. All patients received combined spinalepidural anesthesia. The same concentration（0.8 mg/ml） of morphine in the analgesic mixture was prepared. The patients in group Ⅰ （n = 29） morphine plus naloxone 50 μg, group Ⅱ （n = 32） morphine plus naloxone 40 μg,group Ⅲ （n=28） received PCIA mixture of morphine alone. PCA was set at a 2-ml bolus with a 8-min lockout time, no background infusion. Blood pressure, heart rate, SpO2,consumption of morphine and side effects were recorded during PCIA. VAS pain score was assessed at 2,6 and 24 h after operation. The requirements for ondansetron treatment were recorded as well. Results There was no significant difference in VAS among the three groups. So did the morphine consumption. The incidences of nausea for group Ⅰ , Ⅱ and Ⅲ were 58. 6%, 65.6% and 64.2% ,those of vomiting 31.1% ,34.3% and 35.7% ,and those of skin pruritus 41.3% ,40.6% and 42.8% ,respectively. Conclusion Addition of small dose naloxone in the morphine PCIA solution can not reduce morphine requirement and its side effects in the patients underwent lower limb surgery.
出处
《临床麻醉学杂志》
CAS
CSCD
2007年第6期451-453,共3页
Journal of Clinical Anesthesiology
