地塞米松复合新斯的明和吗啡硬膜外隙给药用于术后镇痛的研究

Epidural administration of dexamethasone combined with neostigmine and morphine for postoperative analgesia

目的 研究地塞米松硬膜外隙给药对新斯的明、吗啡术后镇痛效果和并发症的影响。方法 6 0例ASAⅠ～Ⅱ级腹部手术的患者随机分为 2组 :新斯的明复合吗啡组 (N组 )和新斯的明复合吗啡加地塞米松组 (ND组 )。均行连续硬膜外麻醉。手术结束前 0 .5h ,N组患者经硬膜外导管给予含新斯的明和吗啡各 1mg的生理盐水溶液 10ml,ND组患者在N组给药基础上加用地塞米松 5mg。分别在手术结束后 4h、8h、12h、2 4h、4 8h观察患者疼痛评分和恶心呕吐、尿潴留、皮肤瘙痒、心动过缓等并发症的发生率。结果 患者术后 2 4h内各时刻的疼痛评分 2组间比较无显著统计学差异 ;术后 4 8h ,N组和ND组疼痛评分分别为 (5 .2± 2 .1)分和 (3.6± 1.5 )分 ,N组显著高于ND组。N组患者术后 4 8h恶心呕吐、尿潴留、皮肤瘙痒的发生率分别为 5 3%、5 0 %和 2 5 % ,而ND组相应并发症发生率分别为 2 0 %、4 3%和 2 0 % ,ND组恶心呕吐的发生率明显低于N组。 2组患者均无心动过缓发生。结论 地塞米松硬膜外给药不仅能增加吗啡和新斯的明的术后镇痛作用 。

Objective To investigate the effects of epidural dexamethasone on the postoperative analgesia induced by epidural neostigmine and morphine and on its complications.?Methods Sixty patients (ASA scaleⅠ～Ⅱ) undergoing abdominal surgery were randomly assigned to group N and group ND. Group N was given 1 mg neostigmine and 1 mg morphine in 10-ml saline via epidural catheter 30 min before the end of operation, Group ND was given equal volume saline solution containing 5 mg dexamethasone in addition to equal contents of neostigmine and morphine. At 4 h, 8 h, 12 h, 24 h and 48 h after operation, the score of pain and incidences of postoperative nausea and vomiting (PONV), urinary retention and bradycardia, were recorded.?Results The scores of pain 4 h, 8 h, 12 h and 24 h after operation showed no significant differences between the two groupsa, but at 48h after operation, the difference was significant, with the scores being 3.6±1.5 in group ND and 5.2±2.1 in group N. The incidence of PONV in group ND was significantly lower than in group N in the whole postoperative course.?Conclusion Epidural administration of dexamethasone can significantly strengthen the analgesic effect and decrease the incidence of PONV of neostigmine and morphine.