吗啡蛛网膜下腔术后镇痛在临床中应用及风险防范

The clinical application and risk containment of postoperative pain relieve by morphine used in subarachnoid space

目的回顾盐酸吗啡蛛网膜下腔术后镇痛在下腹部及下肢手术临床应用及风险防范。方法选择符合条件的病人中蛛网膜下腔单次注射吗啡272例,配方为布比卡因10 mg,50%葡萄糖溶液10 mg,吗啡0.5 mg。术前30 m in给予肌注阿托品0.5 mg和鲁米那0.1 g,入手术室后给予开通静脉,输入平衡液,常规心电监护仪监测,术中不用其它镇静药,术后严密观察病人的生命体征,病房备有抢救设备。结果麻醉效果好,一般情况佳,术后并发症少,术后镇痛效果好,但有五例发生较严重的呼吸抑制。结论盐酸吗啡蛛网膜下腔术后镇痛效果很好,但应严格掌握好适应证,否则会有严重后果。

Objective To review clinical application and risk containment of morphine hydrochloride used in subarachnoid space for postoperative pain relieve in abdominal and lower extremity operations. Methods Two hundred and seventy two patients were selected for the study. 0.5mg of morphine hydrochloride associated with 10 mg of bupivacaine and 10mg of 50% glucose were injected into the subarachnoid space of the patient. 0.5rag of atropine and 0. 1 g of luminal were then administered by Intramuscular injection 30 minutes before operation. In operating room, the bal- anced solution was given by intravenous infusion. Electrocardiogram was monitored. No sedative was used during operation. Results Most patients showed satisfactory analgesic effect without side effect except five patients with severe postoperative respiratory depression. Conclusion Morphine hydrochloride used in subarachnoid space for postoperative pain relieve is very effective. However, the indication must be strictly controlled to prevent serious consequence.