静脉注射低剂量国产盐酸纳布啡预防下肢骨科手术鞘内吗啡镇痛引发瘙痒的临床观察

Clinical observation of prophylactic effectsof intravenouslow dosedomesticnalbuphineon pruritus caused by intrathecal morphineanalgesia for lower limb orthopedic surgeries

目的:观察静脉注射低剂量国产盐酸纳布啡注射液预防下肢骨科手术术后鞘内吗啡镇痛引发瘙痒的效果。方法:选择在蛛网膜下腔麻醉下行关节镜交叉韧带重建术患者120例,美国麻醉医师协会(ASA)分级Ⅰ或Ⅱ级,年龄18~60岁,采用随机数字表法分为对照组(C组)和纳布啡组(N组),每组60例。N组于穿刺前10 min静脉注射0.05 mg/kg盐酸纳布啡注射液(生理盐水稀释至2 mL),C组静脉注射2 mL生理盐水,穿刺成功后于蛛网膜下腔给予吗啡0.3 mg和1%罗哌卡因2 mL。观察并记录给药后24 h内患者瘙痒程度评分、疼痛视觉模拟评分(VAS)、Ramsay镇静评分以及寒战、恶心、呕吐和呼吸抑制等不良事件发生情况。结果:鞘内吗啡给药后24 h,N组瘙痒发生率明显低于C组(P<0.05),且N组瘙痒程度明显降低(P<0.05);与C组比较,N组静脉注射0.05 mg/kg盐酸纳布啡后0.5 h和1 h Ramsay镇静评分明显增高(P<0.05),VAS评分和不良反应发生率比较,差异无统计学意义。结论:低剂量国产盐酸纳布啡注射液可以有效缓解下肢骨科手术鞘内吗啡镇痛引发的皮肤瘙痒,且具备可接受的镇静作用,未见严重不良反应。

Objective:To observe the prophylactic effects of intravenous low dosedomestic nalbuphine on pruritus caused by intrathecal morphine analgesiafor lower limb orthopedic surgeries.Methods:A total of 120 patients(ages 18 to 60 years,ASA class Ⅰ or Ⅱ) who underwent arthroscopic anterior cruciate ligament reconstruction were randomly divided into control group(group C) with 60 cases and nalbuphine group(group N)with 60 cases.Group N was intravenously injectednalbuphine 0.05 mg/kg(diluted into 2 ml with normal saline),Group C was intravenously injected 2 mL normal saline 10 min before spinal anesthesia.All patients received spinal anesthesia in L3-4 interspace and subarachnoid injection of 1% ropivacaine 2 mL and morphine 0.3 mg.Pruritus severity score in 24 h after administration,ramsay sedation score,visual analogue scale(VAS),chills,nausea,vomiting,hypotension and respiratory depression were recorded.Results:Within 24 hhours after administration,the incidence of pruitus in control group and treatment group were 38.3% and 18.3%.The incidence of pruritus in 24 h after administration was significantly lower in the group N compared to the group C(P<0.05).The ramsay sedation score at 0.5 h and 1 h after administrationwere significantly higher in the group N compared to the group C(P<0.05).In addition,there were no significant difference in the VAS scale and the incidence of adverse effects between the two groups.Conclusion:Low dosedomesticnalbuphineis effective for remission pruritus caused by intrathecal morphine analgesiafor lower limb orthopedic surgeriesand produce a acceptable sedation effect and no serious adverse reactions were observed.