硬膜外腔及蛛网膜下腔注射吗啡诱发瘙痒的比较

Pruritus after intraspinal morphine for postoperative analgesia

目的:比较硬膜外、蛛网膜下腔吗啡镇痛诱发瘙痒的特点。方法:120例经腹腔子宫切除的病人被随机分为两组,蛛网膜下腔吗啡0.5mg镇痛组(n=60,ITM组);硬膜外吗啡2mg镇痛组(n=60,EA组)。观察瘙痒发生率,术中、术后4、8、12、24、32、48小时瘙痒评分、总瘙痒评分以及发生、持续时间、发生部位。结果:(1) ITM组发生率87%,其中瘙痒评分≥2占27%,总瘙痒评分8(0～18);EA组分别为31%,12%,6(0～14)。组间比较差异有显著性(P<0.05);(2) ITM组发生时间1.5(0.13～8)小时,持续时间27.2(0.5～36)小时;EA组分别为3(1～8)小时、17.5(0.5～32)小时。组间比较有显著性差异(P<0.05);(3) ITM组和EA组瘙痒最多最早发生在面部(尤其是鼻部),其余好发部位依次是上肢、胸腹部、下肢、背部。结论:蛛网膜下腔吗啡易诱发瘙痒,一般于注药后8小时内发生,常见于鼻部,持续不超过36小时。

Objective:To compare the characteristics of pruritus after epidural and subarchoid morphine for postoperative analgesia. Method: One hundred and twenty patients after hysterectomy were randomly allocated to receiving subarchoid morphine 0.5mg(group Ⅰ,n=60)or epidural morphine 2 mg(group Ⅱ,n=60),respectively. The pruritus incidence, pruritus scale, time and site of occurrence were observed in both groups. Result: In group Ⅰ, the pruritus incidence of 87%,27% of pruritus scale being more than 2 and total pruritus scale being 8 (0-18) were significantly higher than those[31%, 12% and 6(0-14)] in group Ⅱ (P<0.05). The occurrance time 1.5(0.13-8)h was shorter and the duration 27.2(0.5-36)h was longer in group Ⅰ than those [3(1-8)h,17.5(0.5-32)h)in group Ⅱ (P<0.05). In both groups, the common and early occured site was the face especially nose,subsequentally arm,chest and abdomen, thigh, and back. Conclusion:Subarchoid morphine may induce pruritus more easily than epidural morphine. The pruritus occurres within 8h following the administration,commonly at nose,lasts 36h at most.