布比卡因复合吗啡硬膜外镇痛对家兔胃肠运动的影响  

Effects of postoperative epidural analgesia with Morphine plus bupivocaine on gastrointestinal motility in rabbits

作　　者：郭文俊[1] 金孝岠[1] 王邦安 张先路[3] 

机构地区：[1]皖南医学院附属弋矶山医院麻醉科,安徽芜湖241001 [2]皖南医学院麻醉系中心实验室,安徽芜湖241001 [3]皖南医学院附属弋矶山医院核医学科,安徽芜湖241001

出　　处：《皖南医学院学报》2005年第3期224-226,共3页Journal of Wannan Medical College

基　　金：安徽省教育厅自然科学研究基金项目 (2 0 0 2kj3 16)

摘　　要：目的　比较吗啡(M )、布比卡因(B)、布比卡因复合吗啡(MB)三组药物用于硬膜外术后镇痛效果,胃动素(MOT)、血管活性肠肽(VIP)血浆浓度与家兔胃肠运动功能的关系。方法　健康家兔、雌雄不限、体重无差异(P>0 .0 5 ) ,喂少纤维饲料3d ,清水1d。随机分为4组,其中生理盐水组(S组) 7只,布比卡因组(0 .15 % )、吗啡加布比卡因组(0 .15 %布比卡因+0 .0 0 2 %吗啡)、吗啡组(0 .0 0 2 % )各为8只,经口插胃管注入美蓝2ml,耳缘静脉注射3%戊巴比妥钠1ml/kg ,分离股静脉采血标本2ml。硬膜外穿刺置管接硬膜外镇痛泵(2ml/h)。术后1h、4h分别采血2ml。标本处理:加入EDTAK2、抑肽酶各30 μl处理的试管,37°C温浴15min ,离心15min(30 0 0r/min) ,采血清检测。4h点标本采集完毕后作疼痛评分,由耳缘静脉注入空气致死,打开腹腔,轻柔分离小肠,剪断,测量美蓝运动距离及幽门至回盲部距离。检测指标:镇痛评分、美蓝运动速率及不同时点的胃动素(MOT)、血管活性肠肽(VIP)。结果　数据采用均数±标准差表示,组间采用方差分析(F检验) ,P <0 .0 5者进一步采用q检验进行两两比较。疼痛评分测定值比较MB组镇痛效果最好(P <0 .0 5 ) ,B组与M组镇痛效果较S组好(P <0 .0 5 ) ;B组、MB组与S组、M组美蓝运动速率测定值比较差异有显著意义(P <0 .0 5 ) ;各组组内血浆MOT测定值比较差异有无显著意义(P >0 .0 5 ) ;各组各时点VIP测定值比较差异无显著意义(P >0 .0 5 )。结论　MB组与B组对胃肠运动功能影响较小;MB组镇痛效果最佳,S组镇痛效果最差;家兔血清MOT、VIP浓度与硬膜外术后镇痛胃肠运动功能相关性较差。Objective To determine gastrointestinal motility by administering morphine, morphine plus bupivocaine and bupivocaine in postoperative epidural analgesia in rabbit; To find out the relationship between Motilin（MOT）, Vasoactive Intestinal Peptide （VIP）and gastrointestinal motility. Methods Thirty-one rabbits were randomly divided into 4 groups： group S （7 rabbits ,average weigh approximately 1.51 kg）received PCEA with 0. 996 saline 50 ml ;group M （8 rabbits ,average weigh approximately 1.58 kg）received PCEA with morphine 2.5 mg plus 0.9%saline to 50 ml ;group B （8 rabbits ,average weigh approximately 1.53 kg） received PCEA with 0.15 % bupivocaine morphine 2.5 rag, group MB （8 rabbits ,average weigh approximately 1.67 kg） received PCEA with 0.15 % bupivocaine, morphine 2.5 mg plus 0.9% saline to 50 ml. In four groups , the background infusion rate was 2 ml/h . Infusion of 2 ml Methylene Blue was done from the gastric tube. The length of Methylene Blue（D）and the whole length of small intestine（L） were measured to determine the rate of Methylene Blue motion（D/L ） and measurement was made for detecting the concentration of MOT and VIP at preoperation in lhour and 4 hours after PCEA . Results The analgesia was satisfactory in group M, group B and group MB than in group S （P〈0.05） , group MB was the best ; The rate of Methylene Blue motion in group MB and group B was higher than that in group S and group M（P〈0.05）. There was no significant difference in concentration of MOT in four groups at three points（P 〉 0.05） and in concentration of VIP among four groups（P 〉0.05）. Conclusion Morphine plus bupivacaine administered in postoperative epidural analgesia can reduce opioid-related side effects and get the best analgesia. There is no marked correlation between MOT, VIP and the rate Methylene Blue motion in rabbit .

关 键 词：吗啡 布比卡因 硬膜外镇痛 美篮移动率 胃动素 血管活性肠肽 胃肠运动 

分 类 号：R333[医药卫生—人体生理学] R971.2[医药卫生—基础医学]