恩丹西酮对硬膜外泵注芬太尼引发瘙痒的影响

Influence of ondansetron infusion on fentanyl-induced pruritus during dpidural fentanyl with patients controlled analgesia

目的 评估恩丹西酮预防患者自控硬膜外镇痛(PCEA)泵注芬太尼引发皮肤瘙痒的有效性及安全性 .方法 选在腰麻和硬膜外联合麻醉下行子宫全切术及疝修补术患者 10 0例 ,术后 1h PECA泵注芬太尼和盐酸布吡卡因合剂 ,随机分成 2组 ,分别 iv恩丹西酮 8mg(A组 )及 iv生理盐水 4m L (B组 ) . 2 4h内定人定时记录皮肤瘙痒的发生率、评分 ,视觉模拟疼痛评分 (VAS) ,芬太尼用量 ,血氧饱和度 (Sa O2 ) ,心率 (HR)及血压 (BP) .结果 恩丹西酮组皮肤瘙痒的发生率及评分分别为 10 %和 0 .3± 0 .8,对照组分别为 2 6 %和 1.1±1.6 ,呈显著差异 (P<0 .0 5 ) ,两组 VAS,芬太尼用量 ,Sa O2 以及 BP相似 .结论 静注 8mg恩丹西酮能安全 ,有效地预防和减少 PCEA泵注芬太尼引发瘙痒的发生率及评分 .

AIM To evaluate the effectiveness and the safety of ondansetron to prevent pruritus during epidural infuse fentanyl with patient controlled analgesia. METHODS One hundred patients classified as ASA status Ⅰ~Ⅲ and sched uled for hysterectomy and hernioplasty under combined spinal and epidural anesthesia(CSE) were enrolled in this study.1 h after operation, all patients received 4 mg·L -1 fentanyl,0.5 mg·L -1 bipivacaine and 2 mg·L -1 adrenarine as PCEA, and they were randomized into two groups to receive either 8 mg ondansetron ( group A) or 4 mL saline (group B) respectively. The incidence rate and score of pruritus, sedation score and visual analog scores (VAS) during the 24 h study were recorded. Blood pressure, oxyhemoglobin saturation and other side effects were also monitored. RESULTS Two groups were similar in demographic characteristics, with all patients receiving about 0.3 μg·kg -1 ·h -1 fentanyl as PCEA. The ondansetron group showed an effective prevention of pruritus. Group A showed an incidence rate of 10% and a score of 0.3 versus 26% and 1.1 for the placebo ( P <0.05). No changes in VAS or sedation levels were noted. Hemodynamic values remained stable, hemoglobin oxygen saturation did not decrease, and no other side effects were observed. CONCLUSION Administration of 8mg ondansetron intravenously in an effective prevention for epidurally administered fentanyl induced pruritus. The prevention is safe and well tolerated.