摘要
目的比较不同剂量纳络酮加等量吗啡对硬脊膜外腔术后镇痛的影响,探讨二药最佳剂量的配比。方法选择硬脊膜外腔阻滞麻醉腹部手术160例,手术分类为胃、十二指肠、肝、胆部位的手术,在T8~T9或T9~T10穿刺点常规穿刺置入硬膜外导管以0.5%罗哌卡因先注入5ml试验量,5分钟后再注10ml^15ml测出麻醉平面后,氟芬合剂+小剂量咪唑安定静脉辅助麻醉,手术结束后硬膜外管注入吗啡2.5mg/5ml+纳络酮分别为0.24mg;0.16mg;0.08mg;0mg;依次为Ⅰ、Ⅱ、Ⅲ、Ⅳ四组,作为首剂量,然后连接Bater镇痛泵1ml/h泵内含0.9%盐水72ml+吗啡7.5mg+纳络酮分别为0.96mg、0.64mg、0.32mg、0mg依次为Ⅰ、Ⅱ、Ⅲ、Ⅳ四组,止痛72h。术后4、8、12、24、36、48、72h随访登记包括疼痛视觉模拟评分VAS:SPO2、R、P、BP、恶心呕吐、皮肤瘙痒、尿潴留发生率、肛门排气时间。结果VAS评分:Ⅱ组<Ⅲ组<Ⅰ组<Ⅳ组;恶心呕吐发生率:Ⅰ组<Ⅱ组<Ⅲ组<Ⅳ组;肛门排气时间:Ⅰ组<Ⅱ组<Ⅲ组<Ⅳ组;恶心呕吐、皮肤瘙痒、尿潴留总发生率:分别为Ⅰ组37.5%;Ⅱ组为32.5%;Ⅲ组为47.5%Ⅳ组为75%;除Ⅳ组一例病人SpO2<90%、R<10次/分列入呼吸抑制外,Ⅰ~Ⅲ组无发现呼吸抑制。结论吗啡伍用小剂量纳络酮注入硬脊膜外腔对术后镇痛效果无影响,并可有效地降低吗啡术后镇痛副作用。吗啡与纳络酮最佳比例是12.5:1。
Objective To compare the effect of analgesia by combining different - dose naloxone with equivalent morphine infused into epidural space during postoperative analgesia, and to explore the best dose of two drugs. Methods 160 patients （undergoing epidural anesthesia, ASA Ⅱ- Ⅲ, scheduled for upper abdominal surgery such a~ stomach,duodenum,liver and gall） were randomly divided into four groups. Selecting T8 - T9 or T9- T10 and placing the epidural catheter, all patients were given 0.5% ropivacaine test dose 5ml, given more 10ml- 15ml and measured the anesthesia flat 5min later, used innovar and small- dose midazolam for the vein assistance anesthesia, When the operation was over, the patients were given morphine （2L5mg/ml） ＋ naloxone of different doses（group Ⅰ： 0.24mg; group Ⅱ ： 0.16mg; group Ⅲ ： 0.08 mg; group IV ： 0 mg） as first dose by the epidural catheter, then placed Baxter analgesic pump of 1 ml/h with 0.9% N. S. 72ml ＋ morphine 7.5rag ＋ naloxone of different doses （groupⅠ ：0. 96mg; group Ⅱ ： 0.64mg; group Ⅲ：0.32mg; group Ⅳ ：0 mg） for 72 hours. After operation for 4,8,12,24,36,48,72 hours, thepain degree by the visual analog pain score （VAS）, Sp02, R, P, BP, nausea- vomiting, pruritus, frequency of urinary retention, anus exsufflation time was recorded. Result Visual analog pain score： group Ⅰ 〈 group Ⅲ 〈 group Ⅰ 〈 group IV; frequency of nausea- vomiting： group Ⅰ 〈 group Ⅱ 〈 group Ⅲ〈 group IV ; anus exsufflation time： group I 〈 group 11 〈 group Ⅲ 〈 group IV ; total frequency of nausea- vomiting, pruritus and urinary retention was 37. 5%,32.5% ,47.5% ,75% from group I to group IV： it was not respiratory depression in each group except one of group Ⅳ for Sp02 〈 90% ,R 〈 10 bpm. Conclusion Small- dose naloxone with morphine infused into epidural space during postoperative analgesia has no effect on analgesia, and it can reduce the side- effects of postoperative analgesia with morphine effectively. It is suggested that the best ratio of morphine to naloxone is 12.5 ： 1.
出处
《中国病案》
2007年第9期44-46,共3页
Chinese Medical Record
关键词
吗啡
纳络酮
硬脊膜外腔
镇痛
morphine
naloxone
anesthesia, epidural
pain, analgesia
