静脉泵入吗啡术后镇痛的血清浓度变化研究

The Analgesic Efficacy of Continuous Intravenous Morphine Infusion on Postoperative Patients

研究持续静脉泵入吗啡术后镇痛的血清浓度变化特点 .方法 :术后患者 4 0例 ,随机分为两组(n =2 0 ) .CI组 :2 4h匀速泵入吗啡 0 5mg/kg ;IM组 :疼痛时肌肉注射吗啡 10mg 观察比较两组病人的镇痛效果 (VAS评分 )、血清吗啡浓度变化、循环呼吸指标、夜间睡眠状况及相关副作用 .结果 :CI组镇痛效果满意 (VAS低 ,轻度疼痛范围内 ) ,某些时段上效果明显优于IM组 (P <0 0 5) .CI组的血清吗啡浓度维持相对稳定 19 4～ 2 5 8μg/L ,在吗啡最低有效镇痛浓度范围内 ;IM组呈尖峰样波动 ,3 0min达峰值浓度( 94 4± 4 3 3 ) μg/L ,远超过吗啡的有效治疗浓度 ,6h后降至 ( 7 7± 5 3 ) μg/L ,低于吗啡的最低有效镇痛浓度 .CI组夜间睡眠状况较IM组佳 (P <0 0 5) .CI组 2 4h吗啡平均用量较IM组低 ,但无统计学意义 (P>0 0 5) .HR ,BP ,RR及SPO2 两组间变化不大 (P >0 0 5) .结论 :静脉泵入吗啡的血清浓度变化特点是其术后镇痛效果持续、稳定、安全、有效、副作用少的药代动力学基础 .

This study was performed to assess the analgesic effect of Morphine on post-operative patients by continuous intravenous infusion, compared with that of routine intramuscular Morphine. Methods: Forty patents (ASA I or II ) were randomly divided into two groups ( n =20). CI group had continuous infusion of Morphine 0.5 mg/kg/24 h while IM group had traditional intramuscular injection of 10 mg Morphine when patients suffered pain. Results: The analgesic effect (low VAS) and night sleep were satisfactory in CI group but not in IM group (high Vas), and there are no significant differences between the two groups in 24h Morphine consumption CI group(25 34±5 33) mg, IM group(26 5±7 45) mg, P >0 05); the minimum effective serum concentration of Morphine was maintained in CI group (19 4～25 8) μg/L, and there was a great variation in IM group ( high 94 4 μg/L, low 7 7 μg/L); HR, BP, RR, VT and SpO 2 showed no significant variation in the two groups ( P >0 05).Side effect and nausea/vomiting occurred in 4 patients of CI group and 8 patients of IM group. Pruritus, respiratory depression were not observed. Conclusion: continuous intravenous Morphine infusion is a safe and effective method to relieve postoperative pain.