小剂量纳洛酮联合氢吗啡酮用于术后硬膜外镇痛的研究

Effect of Adding Low Dose Naloxone and Hydromorphone for Postoperative Epidural Analgesia

目的:探讨纳洛酮联合氢吗啡酮用于剖宫产术后硬膜外镇痛的效果。方法:择期腰硬联合麻醉剖宫产术患者120例,按照随机数字表法分为四组,每组各30例。手术结束时硬膜外腔注射药物6 m L,A组:氢吗啡酮0.6 mg,B、C、D组为氢吗啡酮0.6 mg分别配伍20、40、60μg纳洛酮。术后5、12、24、48 h采用视觉模拟疼痛评分(visual analogue scale,VAS)评估产妇静息(VAS-R)和运动疼痛(VAS-M)。记录追加镇痛药物剂量及瘙痒、恶心呕吐等不良反应。结果:四组产妇各时间点VAS-R、追加镇痛药比较,差异均无统计学意义(P>0.05);与A组相比,C组术后各时间点VAS-M比较,差异均有统计学意义(P<0.05);与C组相比,B组术后5、12 h和D组术后12 h的运动VAS-M显著增加(P<0.05)。与A组相比,C和D组术后5、12 h的瘙痒显著减轻(P<0.05)。四组术后恶心呕吐(postoperative nausea and vomiting,PONV)比较,差异无统计学意义(P>0.05)。结论:硬膜外配伍40μg纳洛酮能够有效减轻氢吗啡酮所致的瘙痒,增强镇痛效应。

Objective： To investigate the effect of adding low dose of Naloxone and Hydromorphone for epidural analgesia in patients after elective cesarean delivery.Method： A total of 120 patients, ASA physical status Ⅰ or Ⅱ scheduled for selective cesarean section under combined spinal-epidural anesthesia were randomly divided into four groups, 30 cases in each group.Then a mixture of Hydromorphone and Naloxone in 6 mL was injected through the epidural catheter postoperatively.Group A： 0.6 mg Hydromorphone, Group B ： 0.6 mg Hydromorphone and 20 pL g Naloxone, Group C： 0.6 mg Hydromorphone and 40 μ g Naloxone, Group D： 0.6 mg Hydromorphone and 60 μ g Naloxone.Patients were assessed for visual analogue scale （ VAS ） at rest （ VAS-R ） and during motion （ VAS-M ） at 5, 12, 24 and 48 h postoperatively.Analgesic requirements, pruritus scores, nausea and vomiting of four groups were also recorded, Result： There were no statistically significant differences in VAS-R and analgesic requirements among four groups （ P〉0.05 ） .And significant lower VAS-M in Group C comparing with Group A at any points （P〈0.05） .Comparing with Group C, VAS-M were significantly higher in Group B at 5, 12 h and in Group D at 12 h postoperatively （P〈0.05） .Group C and Group D provided significantly better relief for pruritus at 5, 12 h postoperatively comparing with Group A （ P〈0.05 ） .No statistical differences were found in postoperative nausea and vomiting among four groups （P〉0.05） .Conclusion： Epidural analgesia with Hydromorphone 0.6 mg and Naloxone 40 μg provides better analgesic efficacy and decreases the incidence of pruritus.