超声雾化吸入吗啡用于妇产科手术后镇痛的研究

Morphine by supersound atomizer for postoperative pain relieve in gynecology and obstetrics patients

目的研究经气管内导管超声雾化吸入吗啡用于妇产科手术后镇痛的效果和可行性。方法80例ASA分级Ⅰ-Ⅱ级，择期行妇产科手术的患者按术后镇痛方式的不同随机单盲分成M1组、M2组、N组和患者自控镇痛（PCA）组，每组各20例。M1组、M2组、N组分别于手术结束前30min经气管内导管超声雾化吸入吗啡15mg、吗啡20mg、0．9％氯化钠10ml，PCA组接静脉PCA泵。术后患者视觉模拟评分（VAS）≥5分时，均可给予补救镇痛。记录拔管后各时间点患者的VAS，并观察各组不良反应发生情况及补救镇痛的使用情况。结果M2组所有时间点的VAS显著低于N组和M1组（P〈0．01）；与PCA组比较，拔管后15min、1h、6h、8h及24h的VAS均显著低于PCA组（P〈0．05或〈0．01）。M1组拔管后15min、30min、1h、2h．4h及6h的VAS显著低于N组（P〈0．05或〈0．01）；而除了拔管后30min与PCA组比较差异无统计学意义外，其余各时间点的VAS均显著高于PCA组（P〈0．05或〈0．01）。M1组和M2组患者恶心呕吐的发生率显著高于N组和PCA组，M1组和M2组比较差异无统计学意义。M1组及N组的补救镇痛使用率（30％和65％）显著高于M2组（0）和PCA组（0）。所有患者均未发生呼吸抑制、皮肤瘙痒等不良反应。结论经气管内导管于手术结束前超声雾化吸入吗啡对妇产科手术后疼痛可产生安全、有效的镇痛效果，但其最佳剂量以及其可能的机制尚有待进一步研究。

Objective To evaluate the efficacy and safety of morphine by supersound atomizer for the management of postoperative pain in gynecology and obstetrics patients. Methods Eighty ASA class Ⅰ - Ⅱ patients scheduled for elective mixed gynecology and obstetrics surgeries were randomly and single-blindly located into 4 groups. Patients in each group received different analgesia therapy 30 rain before the end of the surgeries, as inhaling morphine 15 mg in group M1, inhaling morphine 20 mg in group M2, inhaling normal saline 10 ml in group N and intravenous patient-controlled analgesia （PCA） in group PCA. Open-label rescue analgesia of intramuscular injection pethidine 50 mg or intravenous PCA was also available as needed. Pain scores were measured at basehne, 15 min, 30 min, 1 h, 2 h, 3 h, 4 h, 6 h, 8 h and 24 h after the extubation using visual analog score （VAS）, vital signs, adverse events, and the uses of rescue analgesia were also recorded. Results The VAS of group M2 were significantly lower than that of group N and group M1. The VAS at 15 rain, 1 h, 6 h, 8 h, 24 h of group M2 were significantly lower than that of group PCA（P〈 0.05 or 〈 0.01 ）. The VAS at 15 rain, 30 min, 1 h, 2 h, 4 h, 6 h of group M1 were significantly lower than that of group N （P 〈 0.05 or 〈 0.01 ） postoperatively, which were significantly higher than that of group PCA except for 30 min. The morbidity of postoperative, nausea and vomiting in group M1 and group M2 were significantly higher than those in group N and group PCA. The rescue analgesia was more performed in group M1 and group N than that in group M2 and group PCA. Conclusions Inhalation of morphine by supersound atomizer via intratracheal tube may produce safe and satisfying analgesic effect in postoperative pain model of gynecology and obstetrics patients. More studies are needed to determine what, if any, the optimum dose of morphine is for postoperative pain relieving and the possible mechanism.