蛛网膜下腔注入阿片类药物用于术后镇痛的研究  

CLINICAL STUDY OF POSTOPERATIVE ANALGESIA WITH INTRATHECAL OPIOIDS

作　　者：张云安[1] 边庆虎[1] 姚红娟[1] 邵贵骞[1] 王化民[1] 刘铁民[1] 

机构地区：[1]哈尔滨医科大学附属第一医院麻醉科,哈尔滨150001

出　　处：《中国疼痛医学杂志》2004年第3期161-163,共3页Chinese Journal of Pain Medicine

摘　　要：目的 :将阿片类药物与布比卡因配成重比重溶液用于单纯脊麻 ,观察阿片类药物的术后镇痛时间。方法 :选择ASAI～II级 ,适用于单纯脊麻的手术病人 6 0例 ,随机分为三组。各组麻醉药物 :对照组 (C组 ,n =2 0 )布比卡因 15mg ;芬太尼组 (F组 ,n =2 0 )布比卡因 15mg +芬太尼 2 5 μg ;吗啡组 (M组 ,n =2 0 )布比卡因 15mg +吗啡 5 0 μg。于术后随访病人镇痛情况 ,并记录不良反应。疼痛评价采用视觉模拟评分法 (VAS)。有效镇痛时间 (DEA)为从注药时到病人术后VAS评分≤3。结果 :有效镇痛时间C、F、M组分别为 3.0 4± 0 .5 0h、8.2 5± 1.71h和 10 .5 0± 1.6 8h。F、M组与对照组相比有显著性差异 (P <0 .0 1)。各组不良反应 ,实验组与对照组相比无显著性差异 (P >0 .0 5 )。结论 :蛛网膜下腔注入芬太尼 2 5 μg或吗啡 5 0 μg均有明显的早期术后镇痛作用 ,而且不良反应发生少。Objective:To compare the postoperative analgesic effect of fentanyl 25μg,morphine 50μg and placebo administrated with hyperbaric bupivacaine by subarachnoid injection. Methods: Sixty patients were randomly allocated into three groups. Fentanyl group (F) fentanyl 25μg+bupivacaine 15mg,morphine group (M)morphine 50μg+bupivacaine 15mg,and control group (C) bupivacaine 15mg were intrathecally administrated. Pain scores,additional analgesics and adverse effects were recorded for 24 hours. Duration of effective analgesia (DEA) was defined as the time from intrathecal injection to patients' VAS score ≤3. Results: DEA was 8.25±1.71h in group F and 10.50±1.68h in group M,considerably different from DEA of group C,which was 3.04±0.50h ( P <0.01). VAS scores were significantly decreased in group F and M compared with group C. The requirement of additional analgesics was less in research group than control. There was no differences of the incidence of adverse effects in three groups. Conclusions: The addition of fentanyl 25μg or morphine 50μg to the intrathecal hyperbaric bupivacaine could apparently prolong the duration of effective analgesia,reduce the need for additional analgesia drugs and the adverse effects in early post-operative period.

关 键 词：蛛网膜下腔注药 阿片类药物 术后镇痛 布比卡因 不良反应 

分 类 号：R614[医药卫生—麻醉学]