不同剂量纳洛酮对吗啡术后镇痛病人血浆阿片样物质的影响  

Effect of low-dose naloxone on plasma opiate-like substance level in patients receiving patient-controlled intra-venous analgesia with morphine

作　　者：姚鹏[1] 邢准[1] 孟凌新[1] 

机构地区：[1]中国医科大学附属第二医院麻醉科,辽宁沈阳110004

出　　处：《中国医科大学学报》2006年第6期642-644,共3页Journal of China Medical University

基　　金：辽宁省自然科学基金资助项目(20032069)

摘　　要：目的:探讨不同剂量纳洛酮对吗啡术后镇痛效能及血浆阿片样物质的影响。方法:选择ASAⅠ￣Ⅱ级子宫切除、术后使用吗啡静脉自控镇痛病人60例,随机分成3组:M组,镇痛泵中使用吗啡10μg.kg-1.h-1;MN0.05组,在M组用药基础上加纳洛酮0.05μg.kg-1.h-1;MN0.2组:在M组用药基础上加纳洛酮0.2μg.kg-1.h-1。双盲随访3组病人镇痛效果。于入室、术毕、术后6 h、术后24 h及术后42 h采静脉血,用放免法检测血浆阿片样物质(β内啡肽、强啡肽、亮啡肽)水平。结果:MN0.05组视觉模拟评分(VAS)低于M组,MN0.2组在术后6 h VAS评分高于M组,差异均有显著性(P<0.05)。MN0.05组血浆强啡肽、亮啡肽水平在术后6 h、术后24 h均高于M组,β内啡肽水平在术后6 h低于M组,术后24 h高于M组,差异均有显著性(P<0.05);MN0.2组阿片样物质水平与M组比较无显著差异。结论:不同小剂量纳洛酮对吗啡的镇痛效能有不同的影响,其机制与影响阿片样物质的合成及释放有关。Objective： To evaluate the effect of low-dose naloxone on the postoperative analgesic efficacy of morphine and the level of plasma opiate-like substance （OLS） in patients receiving patient-controlled intravenous analgesia （PCIA） with morphine after abdominal hysterectomy. Methods： Sixty female patients with ASA physical status Ⅰ and Ⅱ who were scheduled for abdominal hysterectomy and received PCIA with morphine were randomly divided into 3 groups：group M （10 μg·kg^-1·h^-1 morphine were added in PCIA pump）,group MN0.05 （10 μg·kg^-1·h^-1 morphine and 0.05 μg·kg^-1·h^-1 naloxone were added in PCIA pump）,and group MN0.2（ 10 μg·kg^-1·h^-1 morphine and 0.2 μg·kg^-1·h^-1 naloxone were added in PCIA pump）. The postoperative analgesic efficaey was observed, and the level of plasma OLS ,includ- ing β-endorphin （β-EP）,dynorphin A1-13 （DynA1-13）,and leu-enkaphalin （L-EK）,was determined. Results： Compared with group M,the visual analogue scale （VAS） scores were significantly lower in group MN0.05 and significantly higher in group MN0a （P 〈 0.05）. Compare with group M,in group MN0,05,the plasma levels of DynA1-13 and L-EK OLS were significantly higher at hours 6 and 24 after operation,and the plasma level of β-EP was significantly lower at hour 6 after operation and significantly higher at hour 24 after operation （P 〈 0.05）. No significant difference in the plasma level of OLS was found between group M and group MN0.2.Conclusion： Different doses of naloxone have different effects on the postoperative analgesic efficacy of morphine, which may act by affecting the synthesis and secretion of OLS.

关 键 词：吗啡 纳洛酮 术后镇痛 阿片样物质 

分 类 号：R614[医药卫生—麻醉学]