芬太尼椎管内麻醉的镇痛效果及锥体外系反应的临床研究

Analgesia effect and extrapyramidal reaction induced by fentanyl spinal anesthesia

目的观察芬太尼椎管内麻醉导致的椎体外系反应,并研究其发生的作用机制。方法将80例患者随机分为A、B两组,每组40例。A组单用0.5%左旋布比卡因对患者进行椎管内麻醉,B组采用0.5%左旋布比卡因联合芬太尼对患者进行椎管内麻醉,比较两组患者术中及术后发生椎体外系反应的情况。结果 A组有1例并发症,表现为乏力、嗜睡;B组有3例发生锥体外系反应,表现为精神紧张,呼吸急促、肌肉震颤、肌张力增高等症状(P<0.05)。结论术中及术后使用芬太尼进行镇痛时,可发生锥体外系反应,芬太尼的镇痛作用机制可能是其与脊髓背角的阿片受体结合,从而达到镇痛的效果。

Objective To study the extrapyramidal reaction induced by fentanyl spinal anesthesia and its mechanism.Methods 80 patients were randomly divided into group A and group B,40 cases in each group.The patients of group A used 0.5% bupivacaine spinal anesthesia,and the patients of group B used 0.5% bupivacaine combined with fentanyl spinal anesthesia.Extrapyramidal reactions of the two groups were compared.Results Group A had one case of complications,manifested as fatigue,drowsiness.Group B had three cases of extrapyramidal reactions,manifested as nervousness,rapid breathing,muscle tremors,increased muscle tone,etc.Conclusion Extrapyramidal reactions may occur during using fentanyl analgesia.The mechanism of fentanyl analgesia may be related to its combination with opioid receptors of the spinal cord dorsal corner,resulting in analgesic effect.