不同剂量纳洛酮对吗啡术后镇痛病人血浆阿片样物质的影响

Effect of low-dose naloxone on plasma opiate-Eke substance level in patients receiving patient-controlled intra-venous analgesia with morphine

目的探讨不同剂量纳洛酮对吗啡术后镇痛效能及血浆阿片样物质的影响。方法选择ASAⅠ～Ⅱ级子宫切除、术后使用吗啡静脉自控镇痛病人60例,随机分成3组：M组,镇痛泵中使用吗啡10μg·kg^-1·h^-1；MN0.05组,在M组用药基础上加纳洛酮0.05μg·kg^-1·1h^-1；MN0.2组：在M组用药基础上加纳洛酮0.2μg·kg^-1·1h^-1。双盲随访3组病人镇痛效果。于入室、术毕、术后6 h、术后24h及术后42h采静脉血,用放免法检测血浆阿片样物质（β内啡肽、强啡肽、亮啡肽）水平。结果MN0.05组视觉模拟评分（VAS）低于M组,MN0.2组在术后6hVAS评分高于M组,差异均有显著性（P〈0.05）。MN0.05组血浆强啡肽、亮啡肽水平在术后6h、术后24h均高于M组,β内啡肽水平在术后6h低于M组,术后24h高于M组,差异均有显著性（P〈0.05）；MN0.2组阿片样物质水平与M组比较无显著差异。结论不同小剂量纳洛酮对吗啡的镇痛效能有不同的影响,其机制与影响阿片样物质的合成及释放有关。

Objective：To evaluate the effect of low--dose naloxone on the postoperative analgesic efficacy of morphine and the level of plas--ma opiate--like substance （OLS） in patients receiving patient--controlled intravenous analgesia （PCIA） with morphine after abdominal hys-tereetomy. Methods：Sixty female patients with ASA physical status 1 and 11 who were scheduled for abdominal hysterectomy and receivedPCIA with morphine were randomly divided into 3 groups： group M （10μg·kg^-1,h^-1morphine were added in PCIA pump）, group MN0.05（10μg·kg^-1·h^-1morphine and 0.05μg·kg^-1μ·h^-1naloxone were added in PCIA pump）, and group MN0.2（10μg·kg^-1·1h^-1 morphine and 0.2μg·kg^-1·kg^-1·h^-1naloxone were added in PCIA pump）.The postoperative analgesic efficacy was observed, and the level of plasma OLS, includ-A^1-3ing β-endorphi （n β-EP）, dynorphin AIA^1- 3（-13DynA1A^1-3）,and leu--enkaphali （nL--EK）, was determined. Results：Compared with group M, the visual analogue seal （eVAS） scores were significantly lower in group MN0.05 and significantly higher in group MN0.2 （P〈0.05）.Compare with group M, in group MN0.05,the plasma levels of DynA1-13 and L--EK OLS were significantly higher at hours 6 and 24 after operation, and theplasma level of β-EP was significantly lower at hour 6 after operation and significantly higher at hour 24 after operation （P〈0.05）.No significant difference in the plasma level of OLS was found between group M and group MN0.2.Conclusion：Different doses of naloxone havedifferent effects on the postoperative analgesic efficacy of morphine,which may act by affecting the synthesis and secretion of OLS.