不同剂量氟哌利多减少术后吗啡PCA恶心呕吐的临床研究

Prophylactic effects of different dosage of doperidol on nausea and vomiting during morphine patient controlled analgesia

目的 探讨不同剂量氟哌利多 (droperidol)在术后吗啡患者自控镇痛 (patient controlled analgesia,PCA)治疗中对恶心、呕吐的预防作用 .方法 12 0例 ASA - 级择期胸部手术患者用镇痛泵行静注吗啡 PCA术后镇痛 ,随机双盲法分为 4组 , 组为单纯吗啡组 ,4 0 mg吗啡用生理盐水稀释至10 0 m L (对照组 ) ; 组为吗啡液中加入氟哌利多 2 .5 mg (2 5mg· L- 1 ) ; 组为吗啡液中加入氟哌利多 5 mg(5 0 m g·L- 1 ) ; 组为吗啡液中加入氟哌利多 10 mg (10 0 mg· L- 1 ) .观察各组镇痛后 2 4 h内恶心、呕吐的发生率 ,记录吗啡用量、疼痛评分及恶心、呕吐、镇静评分 .结果 与对照组相比 ,只有 , 组恶心、呕吐发生率明显降低 (P<0 .0 5 ) ,但较大剂量氟哌利多 ( 组 )使患者镇静的发生率升高 (P<0 .0 5 ) .结论 中等剂量氟哌利多 (5 0 mg· L- 1 ,0 .12 5 mg·mg- 1吗啡 )可以有效预防静注吗啡 PCA所致的恶心、呕吐的发生 。

AIM To investigate the antiemetic effects of different dosage of droperidol during morphine patient con trolled analgesia. METHODS 120 ASA physical status Ⅰ Ⅲ patients, scheduled for thoracic surgery under general anesthesia, were randomly divided into four groups in double blind way: patient controlled analgesia (PCA) with morphine alone (groupⅠ); a mixture of morphine and either droperidol 25 mg·L -1 (group Ⅱ); or droperidol 50 mg·L -1 (group Ⅲ) or droperidol 100 mg·L -1 (group Ⅳ). The morphine dosage of each group was 400 mg·L -1 . The incidence of nausea, vomiting and sedation within 24 h was observed, the morphine consumption and the scores of pain were recorded too. RESULTS The incidence of nausea and vomiting were decreased significantly in group Ⅲ and group Ⅳ compared with groupⅠ ( P <0.05)and the scores of nausea and vomiting were also lower, but the incidence of over sedation in group Ⅳ was higher than that of groupⅠ. CONCLUSION Moderate dosage of droperidol (50 mg·L -1 , 0.125 mg·mg -1 morphine) could effectively reduce the incidence of nausea and vomiting with fewer side effects during morphine PCA.