硬膜外腔应用新斯的明术后镇痛的临床研究

Postoperative Analgesic Effect of Epidural Neostigmine in Abdominal Surgical Patients

目的 :探讨硬膜外腔应用不同剂量新斯的明 (Neo)的镇痛效果及副作用。方法 :110例行下腹部手术病人 ,随机分为盐水对照组 ( 15例 )、布比卡因对照组 ( 15例 )、Neo 1 0mg组 ( 2 0例 )、Neo 1 5mg组 ( 2 0例 )、布比卡因 +Neo1 0mg组 ( 2 0例 )、布比卡因 +Neo 1 5mg组 ( 2 0例 )。观察注药后 4、8、12、2 4、4 8小时视觉模拟疼痛评分 (VAS)和副作用。结果 :治疗组与两个对照组相比 ,各个时点的VAS评分、镇痛效果优良率、恶心呕吐、呼吸道分泌物增多和副作用发生率均明显增高。加用布比卡因与否均无明显差异性影响。Neo 1 5mg治疗组与Neo 1 0mg治疗组比 ,VAS评分、恶心呕吐发生率均存在明显差异。结论 :硬膜外腔应用Neo术后镇痛 ,效果是确实的 ,而且存在剂量依赖关系 。

Objective: The efficacy and side effects of epidural neostigmine for postoperative analgesia were evaluated in patients undergoing abdominal surgery. Methods: One hundred and ten patients were randomly divided into six groups: The saline control group (C group, n= 15), the bupivacaine 15mg control group (B group, n= 15), the neostigmine 1 0mg group (N 1 group, n= 20), the neostigmine 1 5mg group (N 2 group, n= 20), the bupivacaine 15mg and neostigmine 1 0mg group (N 1B group, n= 20),the bupivacaine 15mg and neostigmine 1 5mg group (N 2B group, n= 20).Side effects and the need for analgesic were recorded for the first 48 hours following surgery and scored by a 10 cm visual analog scale (VAS) at 4、8、12、24 and 48 hour following surgery. Results: Compared with the control, analgesic efficacy of epidural neostigmine treatment groups were better (P<0 05 or P<0 01), the 4、8、12、24 and 48 hour VAS scores of the neostigmine treatment groups following surgery were lower (P<0 01), and the rats of the side effects including nausea, vomiting and increased bronchial secretions were higher (P<0 05 or P<0 01). No statistically significant difference was appreciated among the N 1group and the N 1B group or the N 2 group and N 2B group. Neostigmine produced a dose dependent reduce of the VAS scores following surgery. Conclusion: The efficacy of epidural neostigmine for postoperative analgesia is reliable and a neostigmine dose related trend is significant in its analgesia and side effects. Addition of bupivacaine had no significant influence on the analgesic effect of neostigmine. The usefulness of epidural neostigmine as the sole postoperative analgesic may be restricted by the severity of its side effects.