摘要
观察了50例无心、肺疾患,ASAⅠ~Ⅱ级的子宫或卵巢部分或全切除的患者术后硬膜外注射 2.5mg吗啡的 CO2通气反应、止痛效应、脉搏氧饱和度(SPO2)和呼出气CO2分压(PETCO2)变化。硬膜外注药后 1、3、6、9和 12小时的CO2通气反应值,分别自术前8573(均值)降至 5 513、3 945、3398、4268和 5 2351ml· kPa-1· min-1。最大降低值发生在注药后 6小时有29例,3小时11例,9小时10例。 4例于注药后145~450分钟SpO2降至92%~95%,15例PErCO2于注药后100~480分升达6.13~7.20kPa.而呼吸频率无明显改变。呕吐(44%)和困倦(16%)发生在注药后80~100分。认为硬膜外小剂量吗啡的中枢呼吸调节抑制作用主要发生在用药后3~9小时。但因有较大个体差异,临床上监测呕吐、困倦、 PETCO2和
To study the effects of epidural low-dose morphine on respiratory center function. 50 patients,aged 20 to 44 years,ASA class Ⅰ to Ⅱ, having undergone elective subtotal hysterectomy finder epidllral block, received epidural morphine (EM ) at a dose of 2. 5mg in 6 ml normal saline for postoperative analgesia (POA). The respiratory frequence (RF). SPO2. end-expired CO2 tension (PETCO2) and minute volume of ventilation (VE ) were recorded during whole procedures. The ventilatory response to CO2 (VRCO2 ) was measured by a rebreathing technique with 40 % 50% oxygen supply. its value was calculated according to the formu la: (VE1-VE2) / (PET1CO2-PET2CO2). The effect of POA was assessed by verbal rating scale. The results showed that the mean values of VRCOZ were 8573, 5513. 3945, 3398, 4268 and 5235 ml. kPa-1' min-1,before EM. 1, 3, 6. 9 and 12.hours after EM,respectively. Following EM,the lowest level of VRCO2 were between 21 % and 63% of baseline,and occurred at 3rd hour in 11 patients. at 6th hour in 29 patients,and at 9th hour in 10 patients. The late of good POA was 96%. Reduction of SpO2 started between 145 and 450 mins after EM in 4 patients, with the degree of 5%. In 15 patients, 100-480 mins after EM,PETCO2 began to increase,and was ascended to the level 6.0~7. 2 kPa. So we suggest that EM at low dose may produce the depressive effects on the function of respiratory center,which is attributed to the subsequent cephalad spread of morphine in cerebrospinal fluid,and the depressive degree varies widely among individuals. It is necessary that continuous monitoring of SpO2,PETCO2 last 12 hours following AM.
出处
《中华麻醉学杂志》
CAS
CSCD
北大核心
1995年第12期541-543,共3页
Chinese Journal of Anesthesiology
关键词
硬膜外止痛
吗啡
呼吸抑制
Morphine Ventilatory response to CO2 Epidural administration