蛛网膜下腔注射吗啡或吗啡复合可乐定用于前列腺癌根治手术后镇痛的有效性研究  

作　　者：Gregoire Andrieu Benjamin Roth Laoual Ousmane Michel Castaner Patrice Pefillot Benoit Vallet Arnauld Villers Gilles Lebuffe 浦少锋(译) 杜冬萍(校) 

机构地区：[1]Departments of Aaesthesiology and Intensive Care [2]Urology, Lille University Hospital, rue Michel Polonovski, 59000 Lille. France [3]不详

出　　处：《麻醉与镇痛》2010年第6期88-92,共5页Anesthesia & Analgesia

摘　　要：背景在此项随机研究中，我们比较了行耻骨后前列腺癌根治术的患者手术后采用蛛网膜下腔（IT）注射吗啡或吗啡复合可乐定镇痛与静脉自控吗啡镇痛（PCA）的疗效。方法将50例患者随机分为蛛网膜下腔注射吗啡组（4μg／kg）（M组）、蛛网膜下腔注射吗啡复合可乐定组（1μg／kg）（MC组）及PCA组。每例患者都使用PCA吗啡进行手术后镇痛。首要的观察指标是手术后48小时内吗啡的用量。同时记录首次使用自控吗啡镇痛的时间、静息痛和咳嗽时的疼痛评分、气管内导管拔管时间和副作用（瘙痒、手术后恶心呕吐、呼吸抑制）。结果M组和MC组的48小时内吗啡用量较少，M组的静息痛和咳嗽时的疼痛评分降低并持续到手术后18小时，而MC组则可持续到手术后24小时。并且这两组第1次需要PCA镇痛的时间延迟。手术中MC组舒芬太尼的需求量明显减少。结论蛛网膜下腔注射吗啡镇痛可以显著减少前列腺癌根治术后48小时内的吗啡用量。蛛网膜下腔注射吗啡复合可乐定可以减少手术中舒芬太尼的用量，延后患者需要PCA镇痛的时间，还能延长对静息痛和咳嗽时疼痛的镇痛时间。BACKGROUND： In this randomized study, we compared intrathecal （IT） morphine with or without clonidine and IV postoperative patient-controlled analgesia （PCA） morphine for analgesia after radical retropubic prostatectomy. METHODS： Fifty patients were randomly divided into three groups. They were allocated to receive IT morphine （4 μg/kg） （M group）, IT morphine and clonidine （1 μg/kg） （MC group）, or PCA （PCA group）. Each patient was given morphine PCA for postoperative analgesia. The primary objective was the quantity of morphine required during the first 48 postoperative hours. The first request for morphine, numeric pain score at rest and on coughing, the time of tracheal decannulation and adverse effects （pruritus, postoperative nausea and vomiting, respiratory depression） were recorded. RESULTS： Morphine consumption in the first 48 h was decreased in the M and MC groups. The numeric pain score at rest and on coughing were lower in the M group until the 18th postoperative hour and until the 24th postoperative hour in the MC group. The first re- quests for PCA were delayed in these two groups. The need for intraoperative sufentanil was significantly lower in the MC group. CONCLUSION： IT morphine provided a significant reduction in morphine requirement during the first 48 postoperative hours after a radical prostatectomy. The addition of donidine to IT morphine reduced intraoperative sufentanil use, prolonged time until first request for PCA rescue, and further prolonged analgesia at rest and with coughing.

关 键 词：蛛网膜下腔注射 前列腺癌根治术 自控吗啡镇痛 手术后镇痛 可乐定 复合 有效性 PCA镇痛 

分 类 号：R719.8[医药卫生—妇产科学]