不同剂量丙泊酚治疗吗啡硬膜外注射所致瘙痒患者的疗效观察  

Efficacy of propofol in treatment of epidural morphine analgesia-induced pruritus

作　　者：卢易 赖红燕[1] 张烁 李军[1] 上官王宁[1] LU Yi LAI Hongyan ZHANG Shuo et al(Department of Anesthesiology, the Second Affiliated Hospital, Wenzhou Medical University, Wenzhou 325027, Chin)

机构地区：[1]温州医科大学附属第二医院麻醉科,325027 [2]温州医科大学附属第二医院急诊科,325027

出　　处：《浙江医学》2017年第18期1573-1576,共4页Zhejiang Medical Journal

摘　　要：目的观察不同剂量丙泊酚治疗吗啡硬膜外注射所致瘙痒患者的疗效。方法选择行妇产科、普外科、骨科手术后使用0.15%罗哌卡因+0.001%~0.003%吗啡持续硬膜外自控镇痛并发瘙痒的50例患者,按数字随机表法分为Ⅰ组(0.2mg/kg丙泊酚)或Ⅱ组(0.4mg/kg丙泊酚),每组25例;分别单次静脉注射治疗瘙痒。观察并比较两组患者给药前,给药后5、15、25、35、45min,给药后24h时瘙痒治疗有效率、瘙痒程度评分及Ramsay镇静评分。结果丙泊酚治疗吗啡所致瘙痒24h内有效率为56.50%~96.30%;两组患者给药后不同时间治疗有效率的差异均无统计学意义(均P>0.05)。两种剂量丙泊酚均在给药后0~5min内起效,且患者在24h内瘙痒无复发;两组患者给药后各时点瘙痒程度评分均较给药前明显改善(均P<0.05),但两组间各个时点的差异均无统计学意义(均P>0.05)。给药后5min,Ⅱ组有患者出现困倦、嗜睡,Ramsay镇静评分明显高于Ⅰ组(P<0.01)。两组患者给药前后血压、心率、脉搏血氧饱和度(Sp O2)比较,差异均无统计学意义(均P>0.05)。结论静脉注射0.2mg/kg或0.4mg/kg丙泊酚均可以有效缓解硬膜外注射吗啡所致瘙痒,其中0.2mg/kg剂量的安全性较高。Objective To assess the efficacy of propofol of different doses in treatment of epidural morphine analgesia-induced pruritus. Methods Fifty ASA I or II patients aged 18-65yr undergoing elective obstetrical and gynecologi- cal surgery, general surgery or orthopedic surgery, who developed epidural morphine analgesia induced-pruritus were enrolled in the study. Patient controlled epidural anesthesia （PCEA） with 0.15% ropivacaine＋0.001%-0.003% morphine was given after surgery in all patients. Patients were randomly assigned to receive 0.2mg/kg propofol, i.v （group I, n=25） or 0.4mg/kg propofol i.v （group II, n=25）. The efficacy was evaluated with numerical rating scale （NRS） and Ramsay sedation score before propofol administration and 5, 15, 25, 35, 45min, and 24h after drug administration, and the adverse reactions were recorded. Results The effective rate of propofol was 56.50% - 96.30% within 24h. Compared with the baseline value, the NRS was significant lower after the propofol administration in both groups（P〈0.01）, and there was no significant difference in effectiveness at all time points between two groups （ all P 〉0.05）. The itch alleviation began within 0 - 5min after propofol injection and there was no recurrence within 24 hours in both groups. Compared with group I , the patients in group II showed sleepy and lethargy 5 min after propofor administration and the Ramsay sedation score was higher （P〈0.01）. There were no significant differences for blood pressure, heart rate, and pulse oxygen saturation between two groups. Conclusion Intravenous injection of 0.2 or 0.4mg/kg propofol can alleviate the epidural morphine-induced pruritus effectively, while the safety of 0.2mg/kg propofol is higher.

关 键 词：丙泊酚 瘙痒 吗啡 硬膜外镇痛 

分 类 号：R614[医药卫生—麻醉学]