小剂量吗啡、地塞米松及吗啡-地塞米松伍用布比卡因对硬膜外腔术后镇痛作用疗效观察

Analgesic effects of small doses of morphine with dexamethasone and them with bupivacaine on epidural operation plus

目的探讨吗啡、地塞米松、布比卡因硬膜外腔术后镇痛效果和伍用后是否可提高镇痛效果并减少副作用。方法 75例硬膜外腔麻醉下行兰尾、疝气及骨科下肢手术的患者,随机分为3组,每组25例。A组:吗啡0.01mg/kg+布比卡因;B组:地塞米松+布比卡因;C组:A+B。于术后4、8、12、24、48h记录疼痛评分(VAPS)及副作用的发生情况。结果 A组VAPS评分平均为1.52,有效镇痛17例;B组镇痛效果一般,VAPS评分平均为2.56,有效镇痛12例,与A组比较,有统计学差异(P<0.01);C组VAPS评分平均为1.49,有效镇痛18例,与A组比较,无统计学差异(P>0.05)。结论地塞米松+布比卡因硬膜外腔术后镇痛效果肯定,仅逊于硬膜外吗啡术后镇痛,其优点是无恶心、呕吐、皮肤瘙痒等副作用。小剂量吗啡伍用地塞米松和布比卡因,可减轻恶心、呕吐、皮肤瘙痒的发生,但尿潴留等副作用无法减轻。

Objective To discuss the analgesic effects of small doses of morphine with ctexametnasone anu., with bupivacaine on epidural operation. Methods 75 cases with epidural anethesia were randomly divided into three groups. Group A.. morphine 0.01mg/kg; Group B： dexamethasone plus bupivacaine; Group C.. A plus B. VAPS and side effects were recorded 4h, 8h, 12h, 24h and 48h after operation. Results The average VAPS of Group A was 1.52. There were 17 cases of effective postoperative analgesia in the group. The analgesic effects of Group B were secondary to those of Group A, because its average VAPS was 2.56 and there were 12 cases of effective postoperative analgesia. Compared with Group A, there was the statistical significance （P〈0.01）. The average VAPS of Group C was 1.49. In this group, there were 18 cases of effective postoperative analgesia. Compared with Group A, there was no statistical significance. Conclusion Although the postoperative analgesic effects of dexamethasone plus bupivacaine are secondary to those of morphine, its effects are affirmative. Besides, it can effectively eliminate such side effects as vomiting and skin itches. 2. Without effects on urine retention, such as vomiting and skin itches can be relieved due to combination of them plus small doses of morphine.