蛛网膜下腔麻醉加用吗啡用于剖宫产术后镇痛的临床观察  

Clinical study of intrathecal morphine in cesarean section

作　　者：李霞[1] 赵文辉[1] 刘芬[1] 李声华[1] 

机构地区：[1]江汉大学附属医院麻醉科

出　　处：《华中医学杂志》2008年第3期207-208,共2页Central China Medical Journal

摘　　要：目的探讨蛛网膜下腔麻醉应用布比卡因复合吗啡,对剖宫产手术后的镇痛效果及安全性的影响。方法选择49例ASAI^II级择期剖宫产病例,随机分为:I组25例,蛛网膜下腔阻滞用药为重比重布比卡因15mg和盐酸吗啡0.2mg;II组(对照)24例,仅用重比重布比卡因15mg。术后镇痛根据患者要求,每次双氯芬酸钠50mg直肠用药。记录两组术后48小时内疼痛评分(VAS,0~10)、术后6、24小时测量两组动脉血气值。结果术后24小时内,I组疼痛VAS评分明显低于II组(P<0.05),且首次使用双氯芬酸钠的时间明显长于II组(P<0.01),48小时内总消耗量I组明显少于II组(P<0.01)。两组均未见呼吸抑制发生。结论蛛网膜下腔注射吗啡,可减轻剖宫产术后疼痛。Objective To evaluate the effects of intrathecal morphine on postoperative analgesia and the safety. Methods Forty-nine term parturients with ASA Ⅰ - Ⅱ undergoing elective cesarean section with spinal anesthesia were randomly divided into two groups. Patients in experimental group （n = 25） received 15 mg of hyperbaric bupivacaine with morphine 0. 2 mg. In the control group （n = 24）, Saline instead of morphine was added to bupivacaine. After surgery, diclofenac sodium suppositories were provided as required for supplemental analgesia in both groups. During the first postoperative 48 h, visual analog pain scale （0-10）, the time to first request for diclofenac, and total dose of diclofenac were recorded. Level of sedation, sideeffects such as nausea, vomiting, pruritus, urinary retentio, and respiratory depression were also noted. Results During the first postoperative 24 h, patients in experimental group had significantly lower pain score than in control group （P〈0. 05）. The time to first request for diclofenac was longer in experimental group than that in control group （P〈0. 01）. The dosage of diclofenac over 48 h was significantly less in experimental group than that in control group （P〈0. 01）. The incidence of pruritus was significantly higher in experimental group than that in control group （P〈0. 01）. Conclusion Intrathecal morphine of 0. 2 mg reduces postoperative pain and analgesic dosage without obvious side effects except pruritus.

关 键 词：蛛网膜下腔 麻醉 镇痛 吗啡 剖宫产术 

分 类 号：R614[医药卫生—麻醉学]