舒芬太尼静脉自控镇痛对妇科手术患者血浆胃动素及术后恶心呕吐的影响

Effects of patient controlled intravenous analgesia with sufentanil on plasma motilin level and postoperative nausea and vomiting in gynecological patients

目的:研究舒芬太尼静脉自控镇痛对妇科手术患者血浆胃动素水平及术后恶心呕吐的影响。方法:选择50例ASAⅠ～Ⅱ级在腰硬联合阻滞麻醉下行妇科手术的患者,分为P组(n=25)和S组(n=25),P组采用肌注哌替啶50 mg镇痛,总剂量不超过100 mg/d。S组采用患者自控静脉镇痛,负荷剂量为舒芬太尼10%g+生理盐水10 mL静脉注射,背景剂量为舒芬太尼100%g+生理盐水稀释至100 mL,输注速度为1.8～2 mL/h,自控剂量为2～3 mL/h,锁定时间30 min。分别于术前、术后当天及术后第1、2和3天晨抽取空腹静脉血2 mL,放免法测定血浆胃动素含量。同时记录各时点恶心呕吐的发生率。结果:S组患者于术后当天、术后第1天及第2天的血浆胃动素水平均显著高于术前(P<0.01),而术后第3天已经恢复到术前水平(P>0.05)。而P组血浆胃动素水平3 d内均无显著性变化(P>0.05),但显著低于S组水平(P<0.01)。S组术后第1天与第2天恶心呕吐发生率高,第3天发生率显著低于前2 d(P<0.01),其变化与血浆胃动素水平的变化时间一致(P<0.01)。P组术后3 d内恶心呕吐发生率差异无显著性,但显著低于S组(P<0.01)。结论:舒芬太尼静脉镇痛可增加妇科手术患者血浆胃动素的分泌,这可能是舒芬太尼静脉镇痛导致术后恶心呕吐的机制。

Objective To investigate the effect of patient controlled intravenous analgesia（PCIA） with sufentanil on plasma motilin level and postoperative nausea and vomiting in gynecological patients. Methods Fifty patients,ASA Ⅰ～Ⅱ , undergoing gynecological operation under spinal-epidural combined anesthesia, were divided into two equal groups, the traditional meperidine group（Group P） and sufentanil intravenous analgesia group（Group S）. Plasma motilin concentrations were measured by RIA. The incidence of nausea and vomiting were recorded. Results Plasma motilin level at 6 hour, 1 day and 2 day after operation were significantly higher than that before operation in Group S （P 〈 0.01 ）, and in group S plasma motilin level at 3 day after operation returned to the preoperative level （P 〉 0.05）. In Group P, there were no significant changes for plasma motilin level within 3 days afer operation, but that were markedly lower than those in Group S （P 〈 0.01 ）. Nausea and vomiting occurred more frenquently at the first and second day after operation than at the third day after operation （P 〈 0.01 ）, and the variance tendence was consistent with the change of the plasma motilin level（P 〈 0.01）. In Group P, there were no significant changes for the incidence of nausea and vomiting within the first 3 days afer operation, but the incidence of nausea and vomiting were markedly lower than those in Group S （P 〈 0.01）. Conclusion PCIA with sufentanil may increase plasma motilin level in patients with gynecological operation, which may be one of the mechanisms behind the higher incidence of postoperative nausea and vomiting associated with PCIA with tramadol.