鞘内吗啡用于剖宫产术后镇痛最佳剂量的探索  

Exploration of optimal dose of intrathecal morphine combined with ropivacaine for analgesia after cesarean section

作　　者：王晓芳[1] 薛立超[2] 庄萍 段应磊 裴若萌 王晓鹏[2] WANG Xiaofang;XUE Lichao;ZHUANG Ping;DUAN Yinglei;PEI Ruomeng;WANG Xiaopeng(School of Anesthesiology of Shanxi Medical University,Taiyuan 030001,Shanxi,China;The Third Hospital of Shanxi Medical University(Shanxi Bethune Hospital,Shanxi Academy of Medical Sciences,Tongji Shanxi Hospital),Taiyuan 030032,Shanxi,China)

机构地区：[1]山西医科大学麻醉学院,山西太原030001 [2]山西医科大学第三医院(山西白求恩医院山西医学科学院同济山西医院),山西太原030032

出　　处：《中国现代手术学杂志》2024年第2期163-167,共5页Chinese Journal of Modern Operative Surgery

摘　　要：目的观察不同剂量鞘内吗啡复合罗哌卡因用于剖宫产术后镇痛的效果及不良反应,以探索其最佳剂量。方法选取2022年2月至5月ASAⅠ~Ⅱ级、拟在蛛网膜下腔麻醉下行择期剖宫产术的足月单胎产妇150例,随机分为五组。由于各种原因排除8例,A组(对照组,n=28)、B组(n=28)、C组(n=29)、D组(n=29)和E组(n=28)分别采用吗啡0、25、50、100及200μg加用罗哌卡因15 mg鞘内注射,观察手术结束后48 h内首次请求镇痛的时间,记录术中及术后不良反应。结果A组、B组、C组、D组、E组术后48 h首次请求镇痛的时间存在统计学差异(P<0.001),且D组、E组与A组比较差异均有统计学意义(P=0.002、P<0.001),但D组与E组间无统计学差异(P=0.110)。E组瘙痒及恶心呕吐的发生率均高于A组(P<0.001);且E组瘙痒及恶心呕吐的发生率亦较D组增加,差异均有统计学意义(P=0.043、P=0.001)。142例患者均未出现严重的呼吸抑制;仅E组出现尿潴留1例,与A组相比无统计学差异(P=0.169)。Spearman相关分析显示瘙痒、恶心呕吐的发生率与鞘内吗啡剂量有关(r=0.419,P<0.001、r=0.297,P<0.001)。结论采用100μg和200μg剂量吗啡鞘内注射均可为剖宫产术后提供有效镇痛,而应用100μg剂量产妇术后不良反应更少,值得临床推广。Objective To observe the analgesic effects and adverse reactions of different doses of intrathecal morphine combined with ropivacaine after cesarean section,and to explore the optimal dose of intrathecal morphine.Methods A total of 150 single-term parturients with ASAⅠtoⅡgrade who planned to undergo elective cesarean section under subarachnoid anesthesia from February 2022 to May 2022 were randomly divided into 5 groups according to random number table method.8 cases were excluded due to various reasons,and 142 cases were enrolled ultimately.The dose of 0,25,50,100 and 200μg of morphine combined with 15 mg ropivacaine were injected intrathecally in the group A(control group,n=28),B(n=28),C(n=29),D(n=29)and E(n=28)respectively.The time of first analgesia was observed within 48 h after the operation,and adverse reactions were recorded during the operation and after the operation.Results There was significant difference in the time of first request for analgesia within 48 h after cesarean section among the group A,B,C,D and E(P<0.001).Meanwhile,there was significant difference between the group D and A(P=0.002),and the group E and A(P<0.001),but there was no significant difference between the group D and E(P=0.110).The incidence of itching,nausea and vomiting of group E was significantly higher than those of group A(P<0.001).Furthermore,the incidence of itching,nausea and vomiting was also higher in group E than those in group D,and the difference was statistically significant(P=0.043,P=0.001).No severe respiratory depression was found in all patients.Urinary retention occurred in 1 case of group E,and there was no statistical difference between the group E and A(P=0.169).Spearman correlation analysis revealed that the incidence of itching,nausea and vomiting was related to the dose of intrathecal morphine(r=0.419,P<0.001,r=0.297,P<0.001).Conclusion Both dose of 100μg and 200μg intrathecal morphine can achieve effective analgesia after cesarean section,but the former has fewer adverse reactions for parturient

关 键 词：吗啡 罗哌卡因 鞘内注射 最佳剂量 剖宫产术 

分 类 号：R614[医药卫生—麻醉学]