纳美芬对硬膜外吗啡镇痛的影响  

Effect of Nalmefene on Morphine Epidural Analgesia

作　　者：许波[1] 汪小海[2] 王志萍[1] 高宏[1] 

机构地区：[1]南京医科大学附属无锡市人民医院麻醉科,214023 [2]南京市鼓楼医院麻醉科

出　　处：《医学研究杂志》2015年第7期139-141,共3页Journal of Medical Research

摘　　要：目的：纳美芬静脉给药对术后硬膜外单次吗啡镇痛的效果和不良反应的临床观察。方法剖宫产患者90例， ASAⅠ-Ⅱ级，经L2-L3硬膜外腔穿刺置管麻醉，术毕硬膜外导管单次推注吗啡2mg（5ml）后随机分为3组，Ⅰ组静脉注射0.25μg／kg纳洛酮（5ml）；Ⅱ组静脉注射0．1μg／kg纳美芬（5ml）；Ⅲ组静脉注射0．2μg／kg纳美芬（5ml）。观察3组患者术后24h疼痛评分，下肢麻木、恶心、呕吐发生率及皮肤瘙痒的发生情况。结果与Ⅰ组相比，Ⅱ、Ⅲ组的疼痛评分、下肢麻木发生率差异无统计学意义（P＞0．05）；Ⅱ、Ⅲ组在6、12、24h恶心、呕吐发生率及皮肤瘙痒发生率低于Ⅰ组，在3h与Ⅰ组比较，差异无统计学意义（ P＞0．05），Ⅱ、Ⅲ组之间在任何时刻不良反应发生率比较，差异无统计学意义（ P＞0．05）。结论对比小剂量纳洛酮，纳美芬静脉给药可更长时间降低硬膜外吗啡单次镇痛引起的不良反应，镇痛方法可靠而有效。Objective To evaluate the effect of nalmefene in the postoperative treatment of patients with epidural single morphine analgesia on analgesia and adverse reactions.Methods Ninety elective cesarean section of patients,ASA gradeⅠ-Ⅱ,who received postoperative epidural infusion of 2 mg morphine （5 ml）, were randomly divided into three groups（group Ⅰ：iv 0.25μg/kg naloxone （5ml）;groupⅡ：iv 0.1μg/kg nalmefene （5ml）;groupⅢ：iv 0.2μg/kg nalmefene （5ml））.The analgesia effect was evaluated by pain score and the incidence of nausea, vomiting, itching and numbness of lower limb were recorded after injection of 3,6,12 and 24h.Re-sults Compared with groupⅠ, groupⅡandⅢhad no obvious difference with pain score and the incidence of numbness of lower limb. The incidence of nausea, vomiting and itching in groupⅡandⅢwere decreased after 6,12 and 24h and had no difference after 3h com-pared with those in groupⅠ.Moreover,they had no difference between group ⅡandⅢat any time.Conclusion Compared with small doses of naloxone, nalmefene can effectively reduce adverse reactions after postoperative epidural infusion of morphine, which were relia-ble and effective analgesia method.

关 键 词：阿片受体拮抗药 吗啡镇痛 硬膜外麻醉 

分 类 号：R4[医药卫生—临床医学]