不同剂量吗啡鞘内注射对剖宫产术后镇痛效果的影响

Effect of Intrathecal Morphine Injection on Postoperative Analgesia of Cesarean Section

目的 :探讨微量吗啡鞘内注射对产妇的术后镇痛效果的影响及吗啡用于鞘内注射的最佳剂量。方法 :选择ASAⅠ～Ⅱ级足月妊娠产妇 15 0例行剖宫产手术 ,随机分成 5组 (各 30例 )实施腰硬联合麻醉 (CSEA)。对照组 (A组 )用 0 .5 %的布比卡因 2 .5mL(12 .5mg) ,B、C、D、E组为吗啡处理组 ,分别在对照组基础上加用吗啡 0 .1、0 .2 5、0 .5和 1.0mg。评价新生儿情况、术后VAS评分及围术期不良反应。结果 :各组新生儿 1min和 5min时Apgar评分在正常范围 (P >0 .0 5 )。与对照组比较 ,鞘内加入吗啡可使术后无痛时限明显延长 (P <0 .0 1)。术后各吗啡组恶心呕吐及皮肤瘙庠与剂量相关 ,D组和E组病例的恶心呕吐、皮肤搔痒发生率明显高于对照组 (P <0 .0 1)。结论 :吗啡鞘内注射能有效延长剖宫产术后镇痛时间 ,对新生儿无影响 ,具有良好的安全性。其吗啡的最佳剂量为0 .2 5～ 0 .5mg。

Objective: To observe the effect of intrathecal morphine injection on postoperative analgesia of cesarean section.Methods:One hundred and fifty cases of full term pregnancy parturient with ASA grade ⅠtoⅡ were chosen as the objects to be performed cesarean section.They were randomly divided into 5 groups(each included 30 cases)for lumbar anesthesia.The experiment was adopted two arrangements: group A as control (to which 2.5 mL Bupivacaine of 12.5 mg was used)and morphine group B、C、D、E(to which the morphine of 0.1 mg,0.25 mg,0.5 mg,1.0 mg were respectively used on the base of group A).After that,the condition of newborn was evaluated and the analgesia after operation according VAS and the harmful reaction during cesarean section period were investigated. Results: The Apgar score of newborns at 1 min or 5 min among each group were normal( P >0.05).Compared with group B,the time of effective analgesia after operation in each morphine group, was markedly increased ( P <0.01).In each morphine group,after operation there was a correlation between the harmful reaction (such as cutaneous pruritus,nausea,vomiting)and the dosage.In group D and E,the number of cutaneous pruritus,nausea and vomiting was markedly increased compared with group A( P <0.01).Conclusion:Morphine could be safely used in cesarean section and had no effects on the newborn;and meantime, the intrathecal injection of morphine of 0.25～0.5 mg has a good effect on the postoperative analgesia.