小剂量纳洛酮在术后芬太尼静脉自控镇痛中的应用

Application of low dose naloxone in postoperative patient-controlled intravenous analgesia(PCIA)with fentanyl

目的观察术后芬太尼静脉患者自控镇痛(PCIA)中并用小剂量纳洛酮对降低芬太尼副反应的效果,探讨纳洛酮适宜的配伍剂量。方法选择全身麻醉腹腔手术患者238例,ASA I～III级,随机分成3组,A组用芬太尼10～20μg/kg+地塞米松5 mg+生理盐水至100 ml;B组用A组配方再加入纳洛酮5μg/kg;C组用A组配方再加入纳洛酮10μg/kg。定时评定和记录视觉模拟疼痛评分(VAS)、芬太尼用量、恶心、呕吐、皮肤瘙痒发生率。结果3组芬太尼用量无统计学差异,B、C两组纳洛酮泵速分别为0.01±0.12μg/(kg.h)和0.30±0.19μg/(k g.h)(P<0.0 1)。B、C两组恶心、呕吐和皮肤瘙痒发生率均低于A组(P<0.0 5,P<0.0 1)。3组2 4 h内的VAS评分相似(P<0.01)。结论纳洛酮0.10～0.30μg/(kg.h)与芬太尼配伍用于术后镇痛,可保证镇痛质量,而阿片类副反应发生率降低。

Objective To observe the reduced adverse reaction of fentanyl with the application of low dose naloxone in postoperative PCIA with fentanyl and to find the suitable dosage of naloxone. Methods Two hundred and thirty eight general anesthesia cases with abdomen operation were randomly divided into three groups of group A with fentanyl 10-20 μg/kg, desamethasone 5mg and normal saline 100ml, group B with naloxone 5 μg/kg to be added and group C with naloxone 10 μg/kg to be added. The visual analogue scale （VAS）, dosage of fentanyl and the incidences of nausea and vomiting as well as itch were evaluated timely and recorded. Results The doses of fentanyl had not significant difference among the three groups. The pump rates of naloxone in B and C groups were 0.01 ＋ 0.12 μg/（kg · h）and 0.30 ± 0.19 μg/（kg · h） （P〈0.01）, respectively. The incidence of nausea and vomiting and incidence of itch were reduced in B and C groups and had significant difference compared with group A （P〈0.05, P〈0.01）. The VAS grades were similar within the 24h postoperative period among the three groups. Conclusion Low dose naloxone added to fentanyl and pumped as the rate of 0.10-0.30 μg/（kg · h） in postoperative PCIA is feasible and the incidences of the side effects of fentanyl can be decreased.