子宫切除术病人术前鞘内注射不同剂量吗啡复合芬太尼术后镇痛效果的比较  

Comparison of efficacy of different doses of intrathecal morphine and fentanyl before operation for postoperative analgesia in patients undergoing abdominal hysterectomy

作　　者：赵茗姝[1] 高宝柱[1] 赵军[1] 郑宝森[2] 

机构地区：[1]天津市第三中心医院麻醉科,300170 [2]天津医科大学第二医院疼痛科

出　　处：《中华麻醉学杂志》2012年第10期1229-1231,共3页Chinese Journal of Anesthesiology

摘　　要：目的比较子宫切除术病人术前鞘内注射不同剂量吗啡复合芬太尼的术后镇痛效果。方法择期行全子宫切除术病人40例，年龄19～60岁，ASA分级I或Ⅱ级。采用随机数字表法，将病人随机分为2组（n=20），采用脊椎．硬膜外联合阻滞，I组和Ⅱ组术前鞘内分别注射吗啡0．5mg＋芬太尼15μg、吗啡0．2mg＋芬太尼25μg。术后48h内VAS评分≥3时静脉注射吗啡0．05mg／kg进行补救镇痛，记录术后恶心、呕吐和皮肤瘙痒的发生情况。结果与I组比较，Ⅱ组术后镇痛补救率差异无统计学意义（P〉0．05），术后恶心、呕吐和皮肤瘙痒的发生率降低，排气时间缩短（P〈0．05）。结论与术前鞘内注射吗啡0．5mg＋芬太尼15μg比较，子宫切除术病人术前鞘内注射吗啡0．2mg＋芬太尼25μg在提供等效术后镇痛效果的前提下，安全性好，且有利于胃肠道功能恢复。Objective To compare the efficacy of different doses of intrathecal administration of morphine and fentanyl before operation for postoperative analgesia in patients undergoing abdominal hysterectomy. Methods Forty ASA I orⅡpatients; aged 19-60 yr, undergoing abdominal hysterectomy under combined spinal-epidural anesthesia, were randomly divided into I and Ⅱ groups （n = 20 each）. Morphine 0.5 mg ＋ fentanyl 15 μg and morphine 0.2 mg ＋ fentanyl 25 μg were injected intratheeally in groups i and Ⅱ respectively. VAS score ≤2 was considered as effective analgesia. When VAS score≥ 3, morphine 0.05 mg/kg was given intravenously as rescue analgesic. The incidence of nausea and vomiting and pruritus was recorded after operation. Results Compared with group , no significant change was found in the percentage of patients requiring rescue morphine after operation （ P 〉 0.05）, the incidence of nausea and vomiting and pruritus was significantly decreased after operation and the time when the patients passed the flatus was significantly shortened after operation in group Ⅱ （P 〈 0.05 ）. Conclusion Intrathecal administration of morphine 0.2 mg and fentanyl 25 μg before operation is safer and more helpful to recovery of gastrointestinal function than intrathecal administration of morphine 0.5 mg and fentanyl 15μg before operation if they can provide the equivalent postoperative analgesia.

关 键 词：吗啡 芬太尼 注射 脊髓 疼痛 手术后 镇痛 

分 类 号：R614[医药卫生—麻醉学]