摘要
目的观察不同剂量纳洛酮与吗啡联合用于妇科手术硬膜外术后镇痛的效果及不良反应。方法 ASAⅠ或Ⅱ级择期行子宫切除术患者90例,随机分为3组,每组30例。行腰硬联合麻醉,于手术关闭腹膜时硬膜外腔分别注入:Ⅰ组吗啡2 mg;Ⅱ组吗啡2 mg+纳洛酮10μg;Ⅲ组吗啡2 mg+纳洛酮40μg。术后4,8,12,24 h采用视觉模拟评分法(VAS)评价手术部位疼痛,Ramsay评分法评价镇静程度,并记录恶心呕吐(PONV)、瘙痒,呼吸抑制、尿潴留等不良反应及镇痛药和止吐药的追加情况。结果术后4,8,12,24 h VAS评分、Ramsay评分及追加镇痛药情况3组差异无统计学意义。PONV评分:Ⅲ组<Ⅱ组<Ⅰ组(P<0.05);术后追加止吐药的患者,Ⅲ组比Ⅰ组减少(P<0.05);瘙痒例数:Ⅲ组<Ⅱ组<Ⅰ组,分别为6、11和13例,但差异无统计学意义。结论小剂量纳洛酮10μg或40μg与吗啡2mg联合用于硬膜外术后镇痛可以减轻吗啡所致的不良反应且不影响其镇痛效果,后者效果优于前者。
Objective To investigate the efficacy and side effects of different dose of naloxone combined with morphine in postoperative epidural Ninety patients with ASA physical status Ⅰ / Ⅱ ed into three groups, thirty patients per group. analgesia after gynecologic surgery. Methods undergoing hysterectomy were randomly dividPatients were given combined spinal-epidural anesthesia. When the peritoneum was closed the study solution was injected into the epidural space. The dose of naloxone and morphine was 0 μg and 2 mg in Group Ⅰ , 10 μg and 2 mg in Group Ⅱ , and 40 μg and 2 mg in Group Ⅲ. The patients were observed at postoperative 4, 8, 12 and 24 h. The pain was assessed by visual analogue scores （VAS）. The sedation was assessed by Ramsay. The PONV was evaluated by five-point-scaled PONV scores. The incidence of pruritus, respiratory depression, urinary retentin and the dosage of anti-emetic agents were also evaluated at each of four and Ramsay between Group significantly lower than those time points. Results There was no significant difference in VASⅠ , Group Ⅱ and Group m. The PONV scores in GroupⅢ were in GroupⅡ, and the PONV scores in Group Ⅱwere significantlylower than those in Group I （P 〈 0.05 ）. The dosage ot antl-emetlc agents was sgn,nca, uy decreased in Group Ⅲ compared with Group I （P 〈 0.05）. The number of patients with pruritus in Group Ⅲ, Group Ⅱand Group I were 6,11 and 13, but the difference was not statistically significant. Conclusion Naloxone in dose of 10 g and 40 μg combined with morphine
出处
《哈尔滨医科大学学报》
CAS
北大核心
2012年第6期569-572,共4页
Journal of Harbin Medical University
关键词
纳洛酮
硬膜外
术后镇痛
妇科手术
naloxone
morphine
epidural
postoperative analgesia
gynecologic surgery
