不含局麻药单用吗啡行术后硬膜外持续镇痛的可行性  

Feasibility of morphine without local anesthetics for continuous epidural infusion on postoperative analgesia

作　　者：金国庆 李秀军 孙义 张熙哲 陈铁奇 丁海燕 姜志文 郑晔 齐海峰 

机构地区：[1]内蒙古赤峰市第二医院麻醉科,024000 [2]赤峰市中心医院麻醉科,024000

出　　处：《国际麻醉学与复苏杂志》2006年第2期96-98,共3页International Journal of Anesthesiology and Resuscitation

摘　　要：Objective To evaluate the feasibility of morphine without local anesthetics for continuous epidural infusion of postoperative analgesia.Methods Nine-hundred and twenty-five ASA physical status ofⅠorⅡpatients undergoing abdominal or leg surgery were randomly divided into three groups : the morphine-ondansetron group(group MO,n=312),the morphine-bupivacaine-droperidol group(group MBD,n=307),and the morphine-bupivacaine-ondansetron group(group MBO,n=306).In all patients,epidural puncture were performed at L1-2 interspace and a catheter was advanced 3～4cm in the epidural space.Anesthesia was maintained with 1.73% lidocaine carbonate injection.Different loading dose was given via epidural catheter at the end of surgery : group MO,morphine 2mg(5ml);group MBD,morphine 2mg+bupivacaine 20 mg+ droperiodl 1mg(5ml);group MBO,morphine 2mg+bupivacaine 20 mg(5ml).Then different continuous dose in 2ml/h was given in the ward and maintained for 48h: group MO,morphine 4mg and ondansetron 8mg mixture diluted in 0.09% sodium chloride injection to 100ml;group MBD,morphine 4mg+bupivacaine 125mg+droperiodl 3mg mixture diluted in 0.09% sodium chloride injection 100ml;group MBO,morphine 4mg+bupivacaine 125mg+ondansetron 8mg mixture diluted in 0.09% sodium chloride injection to 100ml.MAP,HR,RR,VAS,Prine Henry Score(PHS),and Sedation Scale(SS) were recorded at 2,4,8,16,48h postoperatively.The side effects such as nausea and vomiting(PONV),itching,urinary retention were observed.Results There was no significant difference in MAP,HR,RR,VAS,and PHS among three groups.The SS was significantly higher in group MBD than in other two groups at the same time,(P<0.05).In group MBD,the SS was(2.5±0.5)scores,(2.6±1.3)scores,(2.7±1.4)scores at 2,4,8h postoperatively.The rate of side effects was significantly higher in group MBD than in other two groups.There were 37 cases(12.1%) of SS more than 3 scores in group MBD and no case of SS more than 3 scores in group MO(P<0.01).The rate of urinary retention was 3.8% in group MO and 8.4% in group MBDObjective To evaluate the feasibility of morphine without local anesthetics for continuous epidural infusion of postoperative analgesia. Methods Nine-hundred and twenty-five ASA physical status oflorⅡpatients undergoing abdominal or leg surgery were randomly divided into three groups ： the morphine-ondansetron group （group MO, n = 312）, the morphine-bupivacaine-dropefidol group （group MBD , n =307）, and the morphine-bupivacaine -ondansetron group （group MBO, n =306）. In all patients, epidural puncture were performed at L1-2 interspace and a catheter was advanced 3 -4cm in the epidural space. Anesthesia was maintained with 1.73% lidocaine carbonate injection. Different loading dose was given via epidural catheter at the end of surgery ： group MO, morphine 2mg（5ml） ; group MBD, morphine 2mg ＋ bupivacaine 20 mg ＋ droperiodl lmg（5ml） ; group MBO, morphine 2mg ＋ bupivacaine 20 mg （5ml）. Then different continuous dose in 2ml/h was given in the ward and maintained for 48h： group MO, morphine 4mg and ondansetron 8mg mixture diluted in 0.09% sodium chloride injection to 100ml; group MBD, morphine 4mg ＋ bupivacaine 125mg ＋ droperiodl 3mg mixture diluted in 0.09% sodium chloride injection 100ml; group MBO, morphine 4mg ＋ bupivacaine 125mg ＋ ondansetron 8mg mixture diluted in 0. 09% sodium chloride injection to 100ml. MAP, HR, RR, VAS, Prine Henry Score（PHS）, and Sedation Scale（SS） were recorded at 2,4,8,16,48h postoperatively. The side effects such as nausea and vomiting （PONV）, itching, urinary retention were observed. Results There was no significant difference in MAP, HR, RR, VAS, and PHS among three groups. The SS was significantly higher in group MBD than in other two groups at the same time,（P 〈0.05）. In group MBD, the SS was （2.5 ±0.5）scores, （2.6 ±1.3）scores, （2.7 ±1.4）scores at 2,4,8h postoperatively. The rate of side effects was significantly higher in group MBD than in other two groups. There were 37 cases （ 12. 1% ） of SS more tha

关 键 词：硬膜外持续镇痛 局麻药 吗啡 术后 不良反应 呼吸抑制 恶心呕吐 皮肤瘙痒 镇痛效果 

分 类 号：R614[医药卫生—麻醉学]