芬太尼/哌替啶致Oddi括约肌痉挛的探讨

Study of fentanyl/Pethidine induced Spasm of the sphincter of oddi

200例择期胆囊切除＋术中胆道造影患者分二组：芬太尼1ug／kg静注（F组，n＝100）、哌替啶1mg／kg静注（P组，n＝100）。评价两种麻醉性镇痛药致Oddi括约肌痉挛的发生率，结果：8例病人造影剂不能通过Oddi括约肌、十二指肠不显影，胆总管下端显示“鸟嘴样”或“假结石”影像，后者3例病人胆总管探查明性，静注纳络酮0．4mg后，全部病例造影剂顺利进入十二指肠。结论：硬膜外麻醉辅用小剂量芬太尼／哌替啶时Oddi括约肌痉挛发生率较低，疏忽对假阳性结果的正确鉴别，可导致不必要的胆总管探查，静往纳络酮可有效鉴别之。

Two groups of 100 patients were studied prospectively to assess the incidenceof spasm of the sphincter of Oddi (ISSO ) during elective cholecystectomy andcholangiography under epidural anesthesia with fentanyl/pethidine-supplemented analgesia.We Conclude that the ISSO using fentanyl/pethidine-supplemented is low(4%) , but failure to apprecate it may lead to needless surgical exploration of the CBD . Naloxone may effectively identify narcotic-induced spincter spasm and stone impaction.