阿片类镇痛药与局麻药联合应用于椎管内麻醉的效果评价（英文）  

Application of opioid analgesics combined with local anesthetics to spinal anesthesia

作　　者：库马尔 庞启颖[1] 张晓庆[1] Kumar MUKESH PANG Qiying ZHANG Xiaoqing(Department of Anesthesiology, Tongji Hospital, Tongji University School of Medicine, Shanghai 200065, Chin)

机构地区：[1]同济大学附属同济医院麻醉科,上海200065

出　　处：《外科研究与新技术》2017年第1期48-52,59,共6页Surgical Research and New Technique

摘　　要：尽管在某些手术中椎管内麻醉具有许多潜在的优势,但是也存在许多潜在的缺点,比如由于交感神经阻滞导致的低血压、剂量过大导致药物毒性、以及引起患者恶心和呕吐等。近期有研究表明,鞘内联合应用阿片类药物和局麻药可以产生明显的协同效应,极低浓度的局麻药联合阿片类药物能大大增强镇痛效果。有报道称,阿片类镇痛药辅助应用于椎管内麻醉可以加强神经阻滞,延长感觉和运动神经阻滞的持续时间,提高术中区域麻醉的镇痛效果,延长术后镇痛时间,降低局部麻醉的剂量。因此,为了避免椎管内麻醉相关的不良反应,阿片类镇痛药常作为一种添加剂应用于椎管内麻醉中。通过结合其受体,阿片类药物可以刺激内源性阿片肽的释放,抑制交感神经以减少去甲肾上腺素的释放,从而提高人体疼痛的阈值,起到麻醉作用。Though intravertebral anesthesia has numerous potential advantages in some surgeries, unfortunately it also has numerous potential disadvantages, such as hypotension due to sympathetic block, toxicity due to drug overdose, nausea, and vomiting. Recent experiments have shown that the combined application of intrathecal opioids and regional anesthetics can produce obvious synergistic effect-extremely low concentrations of regional anesthetics combined with opioids greatly enhance analgesic effect. There are reports of opioid analgesics administered in intravertebral anesthesia can improve nerve block, prolong the duration of sensory and motor nerve block, enhance regional analgesic effect during operation, extend the time of postoperative analgesia, and decrease the dose of regional anesthetics. Thus, in an attempt to avoid unpleasant side-effects associated with intravertebral anesthesia, opioid analgesics are offered to patients as an additive to intravertebral anesthesia. Binding to its receptor, opioids can stimulate the release of endogenous opioid peptides, and also inhibit the sympathetic nerve to reduce the release of norepinephrine. Therefore, it can enhance the threshold of body pain.

关 键 词：阿片类止痛药 局麻药 椎管内麻醉 

分 类 号：R614[医药卫生—麻醉学]