小剂量纳洛酮静脉注射未能减低吗啡静脉镇痛的副作用

小剂量纳洛酮静脉注射未能减低吗啡静脉镇痛的副作用 南京军区总医院麻醉科 艾青 张志捷 王春光 何亮亮 朱四海 段满林 徐建国 研究在术后吗啡病人自控静脉镇痛(PCIA)中加用小剂量的纳洛酮对镇痛 效果、吗啡用药量及其副作用的影响。选择ASA ?~?级下肢骨科手术92例，随机分为三组，在所有入选病人中，有3例结果显示可疑而退出。所有病人都在L2~3硬腰联合麻醉下进行手术，术后立即开始PCIA。依用药不同随机分为三组：组I，(28例)，单纯吗啡作为对照；组II，(29例)，吗啡复合纳洛酮洛酮1组，两药浓度比为1600?1；组III，(32例)，吗啡复合纳洛酮2组，浓度比为2000?1。各组静脉泵中的吗啡浓度相同为100 ml生理盐水中加入80 mg吗啡。镇痛泵的设定参数为：PCA量为2 ml/次，锁定时间为8 min，无背景剂量。记录术前病人的年龄、身高、体重等一般情况，记录启动PCA泵前后病人的脉搏血氧饱和度、术后2h，6h，24h病人的视觉模拟评分(VAS)、吗啡的消耗量及恶心、呕吐、瘙痒等副 作用和各处理药物的用量。 根据实际进入的89例研究结果显示各实验组无论在吗啡的 消耗量还是在术后副作用的发生率上差异都无统计学意义, 组I、组II和组III术后恶心发生率分别为64.2％、58.6％和65.6％，呕吐的发生率分别为35.7％、31.1％和34.3％,(P＞0.05)， 瘙痒的发生率分别为42.8％、41.3％和40.6％，另外各组需要应用补救药物的例 数差异也无统计学意义。 在术后吗啡PCIA治疗药液中加入小剂量纳洛酮对减少吗啡消 耗量，降低恶心、呕吐的发生率没有效果。 静脉镇痛；吗啡；纳洛酮；副作用 作者单位：210002 南京，南京军区南京总医院麻醉科 南京大学医学院临床学院 责任作者：徐建国 Dose addition of small dose naloxone reduce the side effects of morphine PCIA AI Qing, ZHANG Zhi-jie, WANG Chun-guang, et al. Department of Anesthesiology, Jinling Hospital, Medical School of Nanjing University, Nanjing 210002, P.R. CHINA [Abstract] Objective To compare the analgesic effect and side effects of morphine for patient-controlled intravenous Analgesia (PCIA) with or without small dose naloxone after lower limb surgery. Methods In this randomized, double-blind study, 92 ASA class I ~II patients underwent lower limb surgery, were allocated to one of three groups. All patients received combined spinal-epidural anesthesia. The same concentration of morphine 0.8 mg/ml in the analgesic mixture was prepared. The patient in group I received PCIA mixture with morphine alone, group II (n=29) morphine with naloxone 50µg , Group ? with naloxone 40µg , PCA was a 2-ml bolus with a 8-min lockout time, no background infusion. Blood pressure, heart rate, SpO, consumption of morphine and side effects were recorded during PCIA. VAS pain score was 2 assessed at 2, 6 and 24 h after operation. The requirements for ondansetron treatment were recorded as well. Results there was no significant difference in VAS among the three groups. So did the morphine consumption. The incidences of nausea were 64.2％, 58.6％ and 65.6％,those of vomiting were 35.7%, 31.1% and 34.3%, and those of skin pruritus were 42.8%, 41.3% and 40.6%, respectively, (P＞0.05). Conclusions Addition of small dose naloxone in the morphine PCIA solution can not reduce morphine requirement and its side effects in the patients underwent lower limb surgery. [Key words] Analgesia；Morphine；Naloxone；Side effect