吗啡经蛛网膜下腔与硬膜外腔给药在肛周术后镇痛效果比较

Comparative Study on Subarachnoid Cavity and Epidural Cavity Administration of Morphine in Perianal Post- operative Analgesia

为比较吗啡经蛛网膜下腔及硬膜外腔给药在肛周术后镇痛的效果，将行肛周手术病人90例随机分为3组．每组30例。I组（C组）仅在蛛网膜下腔注入0．5％罗哌卡因1．5～2ml；II组（S组）在蛛网膜下腔注入0．5％罗哌卡因1．5～2ml内含吗啡0．1mg；nl组（E组）于蛛网膜下腔注入0．5％罗哌卡因1．5-2ml后退出腰麻针，于硬膜外腔一次性注入含吗啡1mg及氟哌利多0．5mg的生理盐水10ml，麻醉平面控制在T8以下。观察记录术后6，12，18，24，48，72hVAs与BCS评分，恶心呕吐、瘙痒、首次排尿时间及尿潴留发生率。结果显示，与c组相比，s组、E组术后VAS评分低（P〈0．05），BCS评分高（P〈0．05）；与c组相比，s组、E组术后首次排尿时间延长，尿潴留发生率高（P〈0．05）。结果表明，吗啡经蛛网膜下腔及硬膜外腔给药用于肛周术后镇痛均可产生良好的镇痛效果，但蛛网膜下腔用药量少，副作用小。

This study was to observe the clinical efficacy of subarachnoid and epidural administration of morphine in perianal postoperative analgesia. Ninety cases undergoing perianal operations were randomly divided into three groups： group I , group II and group III, 30 cases for each. Group I, also called group C,only received subarachnoid administration of 0.5% ropivacaine hydrochloride 1.5-2ml; group II , known as group S, received subarachnoid administration of 0.5% ropivacaine hydrochloride 1. 5-2ml containing morphine 0. ling; for group III known as group E, the spinal needle was withdrawn after subarachnoid ad- ministration of 0.5% ropivacaine hydrochloride 1.5-2ml, and then saline 10ml containing morphine ling and droperidol 0.5mg was injected into the epidural cavity to control anesthesia level below the Ts. All groups were observed for postoperative scores of VAS and BCS （6, 12, 18, 24, 48, 72h after operation）, nausea and vomiting, pruritus, the first urinating time and incidence of urinary retention. As results, compared with group C, postoperative scores of VAS were lower and postoperative scores of BCS were higher in group S and group E（ P 〈0.05, P〈0.05） ;compared with group C, group S and group E had a higher incidence of urinary retention and a later first urinating time. It is concluded that for perianal postoperative analgesia, both subarachnoid and epidural administration of morphine can produce good analgesic effect, but the former is of small dosage and little side effects.