哌替啶 非那根和格拉司琼预防硬膜外阻滞后寒战的临床观察

Clinical study of pethidine,phenergan and granisetron in the prevention of shivering during operation after epidural anesthesia

目的:观察哌替啶、非那根、格拉司琼预防硬膜外麻醉期间寒战反应的临床表现。方法:选择80例准备在硬膜外麻醉下行下腹部、下肢手术的成年患者,随机分为4组:Ⅰ组(杜非合剂组),Ⅱ组(格拉司琼组),Ⅲ组(杜非合剂和格拉司琼组),Ⅳ组(对照组)。四组均于硬膜外麻醉起效后静脉注射哌替啶和非那根合剂半量(Ⅰ组),格拉司琼3mg(Ⅱ组),杜非合剂半量和格拉司琼3mg(Ⅲ组),同等容量的生理盐水(Ⅳ组)。观察麻醉及手术过程中寒战的发生率,寒战的严重程度及术前、术中、术后平均动脉压(MAP)、心率(HR)、血氧饱和度(SpO2)的变化以及用药后的并发症。结果:Ⅰ组、Ⅱ组、Ⅲ组I、V寒战发生率分别为10.0%,5.0%,15.0%,40%,Ⅳ分别与Ⅰ、Ⅱ组比较,差异有统计学意义(P<0.05);Ⅲ组患者术前、术中、术后的MAP、HR、SpO2组间和组内对比,差异均无统计学意义(P>0.05);Ⅰ组、Ⅱ组与Ⅳ组相比嗜睡明显增加(P<0.05),恶心呕吐的发生率各组与对照组相比无统计学意义,但I组与II组组间比较差异有显著性(P<0.05)。结论:硬膜外麻醉后预注杜非合剂和格拉司琼有助于预防硬膜外麻醉后寒战反应,其中两药联用的效果优于单独用药,且并发症少。

Objective：To observe the effects of pethidine,phenergan and granisetron in the prevention of shivering during operation after epidural anesthesia.Methods：80 adult patients enrolled for surgical operation in lower abdomen or lower limbs under epidural anesthesia were allocated randomly to receive mixture of pethidine and phenergnn （haft of on dose） as group Ⅰ or the mixture of pethidine and phenergan （haft of one dose） plus granisetron 3 mg as group Ⅱ or granisetron 3 mg as group Ⅲ and norrmal saline of the same volume as group Ⅳ,all were performed respectively on the priming effect of epidural anesthesia by intravenous injection.The incidence rote of shivering during the operation was observed and the mean arterial pressure（MAP）,heart rate （HR） and arterial oxygen saturation （SpO,） were respectively observed before,during and after operation.Results：The incidence rate in groiups Ⅰ , Ⅱ, Ⅲ and Ⅳ was 10.0%,5.0%, 15.0% and 40% respectively and there was statistically significant difference between group Ⅳ and groups Ⅰ and Ⅱ （P〈0.01）.The difference in MAP,HR and SpO2 before,during and after operation was not statistically significant among groups Ⅰ , Ⅱ and Ⅲ （P〉0.05）.Group Ⅰ was compared with group Ⅱ with significant difference in the incidence of side reaction,nausea and vomiting（（P〈0.05）.Conclusion：Intravenous injection of the mixture of pethidine and phenergan or the mixture of pethidine and phenergan plus granisetron is beneficial to the prevention of shivering after epidural anesthesia,with less complications,and the drug combination is superior to only one alone.