硬膜外小剂量吗啡四种配方术后止痛的比较研究

Epidural morpmne for postoperative pain relief: A comparison of four compounds of morphine

200例 ASA Ⅰ～Ⅱ级,年龄18～44岁,体重45～68 kg 的子宫或卵巢全部或部分切除的患者,以单盲法分为四组,每组50例,分别于术后自硬膜外腔注入①吗啡2.5 mg;②吗啡2.5 mg+中分子右旋糖酐6 ml;③吗啡2.5 mg+纳络酮0.4 mg;④吗啡2.5 mg+5%NaCl 6 ml。比较了注药前及注药后1、3、6、9、12 h 的 CO_2通气反应、止痛效应及副作用。认为2.5 ml 吗啡有满意的止痛作用。但在1～12 h 尤其是3～9 h 有中枢性呼吸抑制作用。右旋糖酐可能减慢吗啡自硬膜外腔向脑脊液的扩散,从而延长术后止痛时间、减轻吗啡的中枢呼吸抑制效应。0.4 mg 纳洛酮与2.5mg 吗啡合用仍保留了止痛作用,在用药后1～3 h,中枢性呼吸抑制作用似有减轻。高渗盐水无明显的止痛作用,不能增强吗啡的止痛效应。

Morphine 2.0 mg and 5% NaCl solution,morphine 2.5 mg and dextran 70,morphine 2.5 mg and n aloxane 0.4mg were compared with morphine 2,5 mg for epidural analgesia in 200 patients undergoing elective subtotol hysterectomy (ASA class Ⅰ～Ⅱ,aged 18～44 yr,weighing 45～68 kg).The CO_2 responese curves were measured 30 rain before and 1,3,6;9 and 12 hr after epidured narcotics.Close monitoring of SpO_2,respiratory rate,'P_(ET)CO_2 via nasa.I cannula was carried for 12 hr. Side effects and pain scores were obtamed The study showed that epidural morphine 2.5 mg provided proper postoperative analgesia and prolonged depression of central respiratory negulation.The depression peaked by 3～9 hr.Morphine 2.5 mg and dextran 70 resulted in a longer pain relief While central respirmtory depression were dimished.It suggested that the dextran molecular absorbed some. morphine and then morphine penetrated the dura to reach the spinal fluid more slowly.Morphine 2.0 mg and 5% NaCl failed to improve analgesia.Epidural naloxane 0.4 mg seemed to increase the slope of CO_2respones curve for 1～6 hr,but this was only significant at 1 and 3 hr.This dose of naloxane did not affect narcotic analgesia.