中华麻醉学杂志
中華痳醉學雜誌
중화마취학잡지
CHINESE JOURNAL OF ANESTHESIOLOGY
2009年
7期
613-616
,共4页
吗啡%镇痛,硬膜外%尿潴留
嗎啡%鎮痛,硬膜外%尿潴留
마배%진통,경막외%뇨저류
Morphine%Analgesia,epidural%Urinary retention
目的 评价吗啡硬膜外镇痛剂量与患者术后尿潴留的关系.方法 择期行膝关节镜手术的患者60例,年龄20～56岁,体重49～76 kg,性别不限,ASA Ⅰ级,随机分为3组(n=20),对照组(C组)硬膜外腔注射生理盐水5 ml;M1,2组硬膜外腔分别注射吗啡1和3 mg.采用Micro Maxx便携式超声仪测量患者膀胱尿量,记录术后产生排尿冲动时的膀胱尿量和首次排尿时间;于麻醉前和术后记录视觉模拟评分(VAS评分);记录术后尿潴留(膀胱尿量≥600 ml且30min内不能自行排尿)、恶心呕吐及瘙痒的发生情况.结果 与C组比较,M2组尿潴留发生率升高,VAS评分降低,M1,2组首次排尿时间延长,产生排尿冲动时的膀胱尿量增多,瘙痒发生率升高(P<0.05或0.01);与M1组比较,M2组尿潴留发生率升高、首次排尿时间延长,产生排尿冲动时的膀胱尿量增多,术后瘙痒发生率升高(P<0.05),VAS评分和镇痛有效率差异无统计学意义(P>0.05).结论 吗啡硬膜外剂量与患者术后尿潴留的发生有关,呈剂量依赖性,1 mg为推荐剂量.
目的 評價嗎啡硬膜外鎮痛劑量與患者術後尿潴留的關繫.方法 擇期行膝關節鏡手術的患者60例,年齡20～56歲,體重49～76 kg,性彆不限,ASA Ⅰ級,隨機分為3組(n=20),對照組(C組)硬膜外腔註射生理鹽水5 ml;M1,2組硬膜外腔分彆註射嗎啡1和3 mg.採用Micro Maxx便攜式超聲儀測量患者膀胱尿量,記錄術後產生排尿遲動時的膀胱尿量和首次排尿時間;于痳醉前和術後記錄視覺模擬評分(VAS評分);記錄術後尿潴留(膀胱尿量≥600 ml且30min內不能自行排尿)、噁心嘔吐及瘙癢的髮生情況.結果 與C組比較,M2組尿潴留髮生率升高,VAS評分降低,M1,2組首次排尿時間延長,產生排尿遲動時的膀胱尿量增多,瘙癢髮生率升高(P<0.05或0.01);與M1組比較,M2組尿潴留髮生率升高、首次排尿時間延長,產生排尿遲動時的膀胱尿量增多,術後瘙癢髮生率升高(P<0.05),VAS評分和鎮痛有效率差異無統計學意義(P>0.05).結論 嗎啡硬膜外劑量與患者術後尿潴留的髮生有關,呈劑量依賴性,1 mg為推薦劑量.
목적 평개마배경막외진통제량여환자술후뇨저류적관계.방법 택기행슬관절경수술적환자60례,년령20～56세,체중49～76 kg,성별불한,ASA Ⅰ급,수궤분위3조(n=20),대조조(C조)경막외강주사생리염수5 ml;M1,2조경막외강분별주사마배1화3 mg.채용Micro Maxx편휴식초성의측량환자방광뇨량,기록술후산생배뇨충동시적방광뇨량화수차배뇨시간;우마취전화술후기록시각모의평분(VAS평분);기록술후뇨저류(방광뇨량≥600 ml차30min내불능자행배뇨)、악심구토급소양적발생정황.결과 여C조비교,M2조뇨저류발생솔승고,VAS평분강저,M1,2조수차배뇨시간연장,산생배뇨충동시적방광뇨량증다,소양발생솔승고(P<0.05혹0.01);여M1조비교,M2조뇨저류발생솔승고、수차배뇨시간연장,산생배뇨충동시적방광뇨량증다,술후소양발생솔승고(P<0.05),VAS평분화진통유효솔차이무통계학의의(P>0.05).결론 마배경막외제량여환자술후뇨저류적발생유관,정제량의뢰성,1 mg위추천제량.
Objective To investigate the relationship between the doses of epidural morphine administered for postoperative analgesia and postoperative urinary retention (POUR). Methods Sixty ASA Ⅰ patients aged < 20-56 yr undergoing atthroscopic knee operation under epidural anesthesia were randomly divided into 3 groups ( n = 20 each) : group Ⅰ and Ⅱ received epidural morphine 1 and 3 mg in 5 ml of normal saline (NS) respectively at the end of operation (group M1, M2 ); group Ⅲ received NS 5 ml instead of morphine (group C). Urinary retention was defined as the patient could not void, when bladder volume was ≥ 600 ml measured using ultrasound. Bladder urine volume was measured before anesthesia and at 4, 6, 8, 10 and 12 h after operation. The occurrence of urinary retention, the first postoperative voiding time, VAS scores and the incidences of vomiting and pruritus were recorded. Results The 3 groups were comparable with respect to age, M/F sex ratio, preoperative bladder urine volume, the amount of local anesthetic used during operation and duration. The incidences of urinary retention, vomiting and pruritus were 65%, 60% and 90% respectively in group M2 and significantly higher than those in the other 2 groups. The first postoperative voiding time was significantly longer in group M2 than in the other 2 groups. VAS scores were significantly lower in group M1 and M2 than in group C. There was no significant difference in VAS scores between group M1 and M2. Conclusion Epidural morphine increases the incidence of POUR in a dose-dependent manner, and 1 mg is the recommended dose.
