维拉帕米在硬膜外术后镇痛中对吗啡的增效作用

Verapamil augments the effect of morphine during postoperative epidural analgesia

目的 比较硬膜外单独注射吗啡与吗啡加维拉帕米在术后镇痛方面的疗效。方法 2 70例在硬膜外麻醉下行腹部手术的患者 ,随机分为三组 ,吗啡加维拉帕米组 (MV组 )、吗啡 1mg组(M 1组 )、吗啡 2mg组 (M2组 ) ,每组 90例。MV组 :吗啡 1mg +维拉帕米 0 2 5mg +0 9%NaCl稀释到 10ml;M 1组 :吗啡 1mg +0 9%NaCl稀释到 10ml;M2组 :吗啡 2mg +0 9%NaCl稀释到10ml。均于手术结束时由硬膜外导管缓慢注入硬膜外腔。观察 15min后拔除硬膜外导管送回病房。手术后 12、2 4、4 8h记录疼痛评分 (VAS)、平均动脉压和呼吸频率、脉搏血氧饱和度 ,以及尿潴留、恶心、呕吐等不良反应情况。结果 术后 4 8h内MV组镇痛效果明显优于M 1组 (P <0 0 5 ) ,与M2组相近 (P >0 0 5 ) ,但不良反应发生率MV组明显低于M2组 (P <0 0 1)。三组的呼吸循环及脉搏血氧饱和度无显著差异。结论 维拉帕米在硬膜外术后镇痛中对吗啡有增效作用 ,可减少吗啡的用量 ,从而减少吗啡的不良反应 。

Objective To compare the theraptic effect of morphine with morphine plus verapamil during postoperative epidural analgesia Methods 270 patients undergoing abdominal operations were randomly divided into 3 groups with 90 cases each Group MV was given morphine 1mg+verapamil 0 25mg+0 9% NaCl diluted to 10ml;Group M1 morphine 1mg+0 9% NaCl diluted to 10ml;and group M2 morphine 2mg+0 9% NaCl diluted to 10ml The analgesic solutions were slowly injected into epidural cavity after operations The epidural catheter was withdrawn 15min after injection The VAS,mean pressure,respiration frequence,oxygen saturation and the side effects such as uroschsis,nausea,vomiting were recorded at 12,24 and 48h of postoperation Results The analgesia of group MV at 48h was significantly better than that of group M1,similar to that of group M2,while the side effects of group MV dramtically were lower than those of group M2 There was no difference in respiration,circulation and oxygen saturation among three groups Conclusion Verapamil augments the effect of morphine,reduces the reqirement of morphine and its side effects during the epidural postoperative analgestia