国际麻醉学与复苏杂志
國際痳醉學與複囌雜誌
국제마취학여복소잡지
INTERNATIONAL JOURNAL OF ANESTHESIOLOGY AND RESUSCITATION
2011年
1期
23-26
,共4页
吗啡%硬膜外%术后镇痛%布托啡诺鼻黏膜喷剂%联合镇痛%安慰剂镇痛
嗎啡%硬膜外%術後鎮痛%佈託啡諾鼻黏膜噴劑%聯閤鎮痛%安慰劑鎮痛
마배%경막외%술후진통%포탁배낙비점막분제%연합진통%안위제진통
Morphine%Epidural%Post-operative anesthesia%Transnasal butorphanol%Combined analgesia%Placebo analgesia
目的 比较术后单次硬膜外注射吗啡-布托啡诺鼻喷剂联合镇痛与否对腹式子宫切除术后镇痛的有效性与安全性.方法 单盲、完全随机、安慰剂对照研究择期ASA Ⅰ～Ⅱ级行腹式子宫切除术的患者50例,分为A、B两组(n=25):均在L2-3硬膜外麻醉下进行手术,关腹前A组接受单次硬膜外注射吗啡0.5 mg(4 ml),鼻喷与B组等剂量的生理盐水(0.1 rnl,q4 h)作安慰剂镇痛;B组于关腹前接受单次硬膜外注射吗啡0.5 mg(4 ml)与鼻喷剂(布托啡诺1 mg～0.1 ml,q4 h)联合镇痛.记录视觉模拟评分法(visual analogue scale,VAS)和Remesay镇静评分,观察血压、脉搏、呼吸、血氧饱和度(SpO2)和有无延迟性呼吸抑制、恶心、呕吐、皮肤搔痒等副作用.结果 B组患者术后(20 h～32 h)VAS评分显著低于A组:两组镇痛药时-效曲线下面积比较,AUCA组=(26.2±6.5),AUCB组=(14.3±5.0),差异有统计学意义(P＜0.01);两组患者镇痛副作用差异无统计学意义.结论 单次硬膜外注射吗啡0.5 mg联合布托啡诺鼻喷剂(1 mg,q4 h)用于腹式子宫切除术后镇痛,其镇痛效果确切、术后镇痛管理容易,适合在基层医院使用.
目的 比較術後單次硬膜外註射嗎啡-佈託啡諾鼻噴劑聯閤鎮痛與否對腹式子宮切除術後鎮痛的有效性與安全性.方法 單盲、完全隨機、安慰劑對照研究擇期ASA Ⅰ～Ⅱ級行腹式子宮切除術的患者50例,分為A、B兩組(n=25):均在L2-3硬膜外痳醉下進行手術,關腹前A組接受單次硬膜外註射嗎啡0.5 mg(4 ml),鼻噴與B組等劑量的生理鹽水(0.1 rnl,q4 h)作安慰劑鎮痛;B組于關腹前接受單次硬膜外註射嗎啡0.5 mg(4 ml)與鼻噴劑(佈託啡諾1 mg～0.1 ml,q4 h)聯閤鎮痛.記錄視覺模擬評分法(visual analogue scale,VAS)和Remesay鎮靜評分,觀察血壓、脈搏、呼吸、血氧飽和度(SpO2)和有無延遲性呼吸抑製、噁心、嘔吐、皮膚搔癢等副作用.結果 B組患者術後(20 h～32 h)VAS評分顯著低于A組:兩組鎮痛藥時-效麯線下麵積比較,AUCA組=(26.2±6.5),AUCB組=(14.3±5.0),差異有統計學意義(P＜0.01);兩組患者鎮痛副作用差異無統計學意義.結論 單次硬膜外註射嗎啡0.5 mg聯閤佈託啡諾鼻噴劑(1 mg,q4 h)用于腹式子宮切除術後鎮痛,其鎮痛效果確切、術後鎮痛管理容易,適閤在基層醫院使用.
목적 비교술후단차경막외주사마배-포탁배낙비분제연합진통여부대복식자궁절제술후진통적유효성여안전성.방법 단맹、완전수궤、안위제대조연구택기ASA Ⅰ～Ⅱ급행복식자궁절제술적환자50례,분위A、B량조(n=25):균재L2-3경막외마취하진행수술,관복전A조접수단차경막외주사마배0.5 mg(4 ml),비분여B조등제량적생리염수(0.1 rnl,q4 h)작안위제진통;B조우관복전접수단차경막외주사마배0.5 mg(4 ml)여비분제(포탁배낙1 mg～0.1 ml,q4 h)연합진통.기록시각모의평분법(visual analogue scale,VAS)화Remesay진정평분,관찰혈압、맥박、호흡、혈양포화도(SpO2)화유무연지성호흡억제、악심、구토、피부소양등부작용.결과 B조환자술후(20 h～32 h)VAS평분현저저우A조:량조진통약시-효곡선하면적비교,AUCA조=(26.2±6.5),AUCB조=(14.3±5.0),차이유통계학의의(P＜0.01);량조환자진통부작용차이무통계학의의.결론 단차경막외주사마배0.5 mg연합포탁배낙비분제(1 mg,q4 h)용우복식자궁절제술후진통,기진통효과학절、술후진통관리용역,괄합재기층의원사용.
Objective To compare the efficacy of epidural morphine with and without transnasal butorphanol on postoperative pain relief following abdominal hysterectomy.Methods This is A single-blind design,randomized,placebo controlled study. 50 patients (ASA Ⅰ～Ⅱ)undergoing total abdominal hysterectomies was conducted to group A and group B (n=25). Following elective abdominal hysterectomy with epidural anesthesia via L2-3,group A of 25 patients received a single epidural bolus of morphine (0.5 mg) with transnasal saline as placebo analgesia (0.1 ml,q4 h),and group B received a single epidural bolus of morphine (0.5 mg) combined with transnasal butorphanol 1 mg ( 0.1 ml,q4 h) for postoperative analgesia. Parameters monitored were pain pulse,respiratory rate,SPO2 and side effects such as nausea,emesis,skin itching and delayed score (Visual Analogue Scale,VAS),sedation score (Remesay sedation score,RSS),blood pressure,respiratory depression.Results Compared with group A,the VAS scores were found to be decreased in group B significantly from 20 h to 32 h after epidural analgesia (P＜ 0.01 ). There was a significant difference in analgesics-effect curve (AUC) (P＜ 0.01 ) between two groups. The incidences of complications were equally comparable in both two groups.Conclusion Single epidural bolus of morphine 0.5 mg with regularly transnasal Butorphanol (1mg,q4h) had a better analgesic effect than placebo analgesia,which is easier to perform in pain management and is practicable for abdominal hysterectomy in the primary hospital.
