吗啡联合不同剂量纳洛酮用于剖腹产病人术后镇痛

Intravenous morphine combined with different doses of naloxone for post-caesarean analgesia

目的研究不同剂量纳洛酮对吗啡静脉镇痛用于产妇镇痛效能及副作用的影响,探讨增强吗啡镇痛效能且拮抗吗啡副作用的合适剂量。方法120例剖宫产术后镇痛患者随机分为4组,采用不同的药物进行术后镇痛,M组:吗啡20μg/(kg.h);MN组为M组中加入纳洛酮,根据纳洛酮的剂量[0.35,0.25,0.15μg/(kg.h)]分为MN1、MN2和MN3组。在镇痛开始后48h内不同时间观察VAS疼痛评分、Ramsay's评分、恶心呕吐、瘙痒、排气时间及呼吸抑制。结果MN1和M组的VAS评分没有统计学差异(P>0.05),但MN1组副作用的发生率显著降低(P<0.01);MN2和MN3组的VAS评分显著低于M组和MN1组(P<0.01),副作用的发生率显著降低(P<0.01)。结论静脉应用0.35μg/(kg.h)的纳洛酮不能增强吗啡的镇痛效能,但能够降低吗啡产副作用的发生率;0.15-0.25μg/(kg.h)的纳洛酮能增强吗啡的镇痛效能,同时降低吗啡副作用的发生率。

Objective To explore the sutiable dose of naloxone to increase the post-caesarean analgesic efficacy of morphine and reverse its side effect in patients after caesarean section.Methods One hundred and twenty ASAⅠ-Ⅱpatients with caesarean section were randomly divided into four groups（n=30 for each group）：20 μg/（kg·h）intravenous morphine alone（group M）,20 μg/（kg·h）intravenous morphine with 0.35 μg/（kg·h）naloxone（group MN1）,20 μg/（kg·h）intravenous morphine with 0.25 μg/（kg·h）naloxone（group MN2）,and 20 μg/（kg·h）intravenous morphine with 0.15 μg/（kg·h）naloxone（group MN3）.The Ramsay sedation score（RSS）,visual Analog score（VAS）,the time of first flatus,and the incidence of pruritus,nausea,vomiting and respiratory depression（respiratory rate〈6 bpm）were recorded at 2,4,8,12,24,36 and 48 h after beginning of analgesia.Results VAS in group MN2 and MN3 was significant lower than that in group M（P〈0.01）.Compared with group M,VAS had no significant difference in group MN1,but the side effects significantly decreased（P〈0.01）.Compared with groups M,RSS signifi-cantly decreased in the other three groups,but there was no significant difference between groups MN2 and MN3.In group MN,the incidence of postoperative nausea and vomiting（PONV）and pruritus decreased and the time of first flatus was shortened（P〈0.01）.Conclusion Doses of 0.15-0.25 μg/（kg·h）naloxone not only enhance the analgesic efficacy of morphine,but decrease side-effects induced by morphine.Naloxone of 0.35 μg/（kg·h）may be the top dose to reverse side effect induced by morphine,but not enhance the analgesic efficacy.