吗啡伍用小剂量纳洛酮镇痛病人胃肠动力变化

Effects of morphine combined with low dose of naloxone on gastrointestinal motility in patients with postoperative analgesia

目的:观察小剂量纳洛酮(50 ng·kg-1·h-1)对吗啡经静脉病人术后自控镇痛(PCIA)时恶心呕吐,首次排气时间及血浆胃动素水平的影响.方法:ASA Ⅰ～Ⅱ级子宫切除患者,术后使用吗啡PCIA.随机分成两组,双盲随访两组病人恶心呕吐,首次排气时间,镇痛效果,并检测血浆胃动素水平.结果:MN组镇痛效能优于M组,恶心呕吐发生率及程度降低,排气时间缩短;从入室到术毕,两组胃动素水平均升高,但M组在术后24 h内仍维持较高水平,而MN组在术后6 h明显降低,24 h有一定程度升高,42 h达分泌高峰.结论:小剂量纳洛酮可减少吗啡PCIA引起的恶心呕吐、促进病人胃肠动力恢复,其机制与延缓胃动素的分泌高峰有关.

Objective： To evaluate the effect of low-dose naloxone （50 ng· kg^-1·h^-1 ） on postoperative intravenous analgesic potency of morphine and investigate its relationship with postoperative nausea and vomiting （PONV）, the time of first flatus, and plasn,a n,otilin in patients. Methods： The ASA Ⅰ to Ⅱ patients who underwent scheduled hysterectomies under spinal-epidural anesthesia were divided randomly into 2 groups. Patients in group M received morphine, and those in group MN received morphine and naloxone for pastoperative analgesia. Postoperative analgesic potency, PONV, and the time of first flatus were observed double-blindly, and the level of plasma motilin （MOT） was recorded. Results： The analgesic efficacy of group MN was significant better than that of group M （ P 〈 0.05 ）. The incidence and degree of PONV decreased and the time of first flatus was shortened in group MN. The level of MOT increased throught operation（ P 〈 0.05 ）. The level of MOT was still high 24 hours after the operation in group M. But in group MN, the level of MOT obviously decreased 6 hours after the operation, increased 24 hours later, and reached the peak 42 hours later. Conclusion： Low dose of naloxone can reduce PONV induced by morphine in postoperative intravenous analgesia and stimulate the recovery of gastrointestinal motility by delaying the development o f the peak of MOT secretion.