胃大部切除术后纳洛酮复合吗啡硬膜外镇痛对肠蠕动的影响  

The influence of epidural analgesia with naloxone and morphine on enterokinesia after subtotal gastrectomy

作　　者：漆志民 

机构地区：[1]浙江省温岭市第一人民医院,浙江温岭317500

出　　处：《现代中西医结合杂志》2008年第18期2764-2765,共2页Modern Journal of Integrated Traditional Chinese and Western Medicine

摘　　要：目的评估纳洛酮复合吗啡应用于硬膜外镇痛对肠蠕动和痛觉消失的影响。方法选择胃大部切除患者143例，ASA1～2级，随机分2组，手术开始前全部硬膜外给予吗啡2mg，开启镇痛泵持续输注0．125％布比卡因复合吗啡5mg共100mL。对照组不加纳洛酮。实验组加入0．2μg／（kg·h）纳洛酮。记录术后肛门排气时间和排粪时间。采用视觉模拟评分记录术后2，4，8，16，32，48h在静息和运动时的疼痛评分。结果实验组和对照组的肛门排气时间分别为（51．9±16．1）h和（87．0±19．5）h（P〈0．01），排粪时间为（95．3±25）h和（132．9±29．4）h（P〈0．01），视觉模拟评分2组无显著性差异。结论硬膜外钠络酮减少吗啡介导的肠蠕动减弱效应．而不扭转其镇痛作用。Objective It is to evaluate the influence of bowel motility and analgesia when naloxone was co-administered with morphine into the epidural space. Methods 143 patients with ASA 1 to 2 grades were divided into 2 groups randomly, All received a bolus dose of 2 mg epidural morphine at the beginning of surgery, followed by a continuous epidural infusion containing 5 mg morphine in 100 mL 0. 125 % bupivacaine with either no naloxone （control group） or a calculated dose of 0.20 μg/（kg· h） of naloxone （experimental group） for 48 h. The time to the first postoperative passage of flatus and feces were recorded. The scores were assessed by visual analog scales （VAS） for pain during rest and movement at 2, 4, 8, 16, 24, 36 and 48 h postoperatively. Results The experimental group had a shorter time than the control group to the first postoperative passage of flatus （ （ 51.9 ± 16.6） h vs （ 87.0 ± 19.5） h, P 〈 0.001 ） and feces （ （95.3 ± 25.0） h vs （ 132.9 ± 29.4） h, P〈 0. 001）. No differences were found in either resting or active VAS between the two groups. Conclusion Epidural naloxone reduces epidural morphine-induced intestinal hypomotility without reversing its analgesic effects.

关 键 词：钠洛酮 硬膜外镇痛 肠蠕动 

分 类 号：R614.4[医药卫生—麻醉学] R614[医药卫生—外科学]