微量吗啡鞘内注射用于剖宫产术后镇痛效果及不良反应的研究  

Analgesic and side effects of small doses of Morphine intrathecal injection in patients undergoing cesarean section

作　　者：夏云飞[1] 郑吉建[1] 王莹恬[1] 崔晓娜[1] 徐子锋[1] 

机构地区：[1]上海交通大学附属第一人民医院麻醉科,上海200080

出　　处：《中国现代医学杂志》2013年第18期78-80,共3页China Journal of Modern Medicine

摘　　要：目的观察微量吗啡术前鞘内注射用于剖宫产术后镇痛效果及不良反应,并探讨其应用剂量。方法选择ASAⅠ～Ⅱ级足月妊娠择期行剖宫产手术产妇120例,随机分为3组,每组40例。分别用吗啡25、50及100μg加用0.5%布比卡因12 mg+10%葡萄糖注射液稀释成2 mL鞘内注射。评价新生儿1 min和5 min Apgar评分,产妇术后24 h视觉模拟评分(VAS评分)及围术期不良反应。结果各组新生儿1 min、5 min Apgar评分在正常范围。产妇均无呼吸抑制发生。25μg组与50μg组相比,术后4、8、12及16 h VAS评分显著增高,而术后20、24 h VAS评分、术后恶心呕吐及皮肤瘙痒发生率均无显著差异;100μg组与50μg组相比,术后各时点VAS评分均无显著差异,而术后恶心呕吐及皮肤瘙痒率明显大于50μg组。结论 50μg和100μg吗啡剖宫产术前鞘内注射可以提供有效的术后镇痛,其中50μg组产妇术后不良反应较少。To compare the spinal analgesia and side effects of 3 small doses of Morphine after Cesarean section.【Methods】120 patients with ASA physical status class Ⅰ～Ⅱ scheduled for elective Cesarean section were randomized to receive 25,50 or 100 microg of Morphine together with 0.5% Bupivacaine 12 mg for intrathecal injection.Visual analogue scale（VAS） scores,Apgar scores of new borns and postoperative side effects were observed within 24 hours.【Results】The Apgar scores of new borns at 1 min or 5 min among each group were normal.No respiratory depression occurred among all the patients.Compared with group 50,the VAS scores in group 25 were significantly higher at 4,8,12,16 hours postoperatively.However,there was no significantly difference in the incidence of postoperative nausea,vomiting and pruritus between the two groups;There was no significantly difference in the VAS scores between group 50 and group 100.However,the incidence of nausea,vomiting and pruritus in group 50 was significantly lower.【Conclusions】Intrathecal usage of 50 microg and 100 microg of Morphine provides effective analgesia in patients undergoing Cesarean section in this patient population.The dosage of 50 microg of Morphine can provide the best balance between analgesic efficacy and side effects.

关 键 词：吗啡 鞘内注射 剖宫产 术后镇痛 

分 类 号：R614.4[医药卫生—麻醉学]