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吗啡与芬太尼联合静脉术后镇痛对患者β-内啡肽的影响
引用本文:冯春芳,闫华,肖玉波,郝玉良.吗啡与芬太尼联合静脉术后镇痛对患者β-内啡肽的影响[J].中国现代医生,2008,46(16):24-26.
作者姓名:冯春芳  闫华  肖玉波  郝玉良
作者单位:冯春芳 (山东省潍坊市第二人民医院麻醉科,山东潍坊,261041); 闫华 (山东省潍坊市第二人民医院麻醉科,山东潍坊,261041); 肖玉波 (山东省潍坊市第二人民医院麻醉科,山东潍坊,261041); 郝玉良 (山东省潍坊市第二人民医院麻醉科,山东潍坊,261041);
基金项目:潍坊市奎文区科技局资助计划课题
摘    要:目的观察吗啡与芬太尼联合术后镇疼对患者β-内啡肽的影响。方法择期肺癌手术患者90例,ASAⅠ~Ⅱ级,随机平均分为三组,全身麻醉术毕前30min,静脉接镇痛泵,A组镇痛泵药液为吗啡0.05mg/(kg·d),芬太尼4 μg/(kg·d),恩丹西酮0.08mg/(kg·d);B组镇痛泵药液为吗啡0.1mg/(kg·d),恩丹西酮0.08mg/(kg·d);C组镇痛泵药液为芬太尼8μg/(kg·d),恩丹西酮0.08mg/(kg·d),三组均用0.9%盐水稀释至100mL,注入速度2mL/h。术后根据患者的疼痛情况,VAS评分5分以上者肌注哌替啶50~100mg镇痛。三组患者均于术前、术毕、术后6h、24h、48h,记录MAP、HR、RR、SPO2,分别于术前、术毕、术后6h、24h、48h采血,放射免疫法测定血浆β-EP的含量。结果B、C两组术毕、术后6h、24h、48hMAP、HR分别与术前相比有显著性差异(P〈0.05)。A组则与术前相比无显著性差异(P〉0.05)。A组的VAS评分低于B、C两组(P〈0.05),B、C两组的镇静评分明显比A组高(P〈0.01)。三组患者术前β-EP含量差别无统计学意义(P〉0.05),术毕各组β-EP含量较术前都显著升高(P〈0.01)。B、C两组术后6h与术前相比β-EP含量显著升高(P〈0.01),而术后24h、48h则与术前明显差异(P〈0.05)。A组术后6h、24h、48h与术前相比均无明显差异(P〉0.05)。B、C两组术毕、术后6h、24h、48h各时间点β-EP含量比A组相应的各时问点均明显高(P〈0.05)。结论吗啡-芬太尼-恩丹西酮经静脉联合应用进行术后镇痛效果确切,副作用小,已能达到胸科开胸手术患者术后有效镇痛的基本要求。

关 键 词:吗啡  芬太尼  恩丹西酮  术后镇痛  β-EP

The Effect of β-Enorphine in Intravenous Postoperative Analgesia with Morphine and Fentanyl
Authors:FENG Chunfang  YAN Hua  XIAO Yubo  HAO Yuliang
Institution:(Department of Anesthesiology,the Second People's Hospital of Weifang,Shandong 261041)
Abstract:Objective To investigate the effecti of β-EP post operative analgesia with intravenous diffrents opioids. Methods Ninty patients, ASA Ⅰ- Ⅱ, undergoing elective surgery were randomly divided into three groups: opioids was pumped for 48h. The capacity of the pump was all 100mL,with 2mL/h backgroud infousion. The group A(n=30) pump solution consist of morphine 0.05mg/(kg·d), fentanyl 4 μg/(kg·d)and Ondansetron 0.08mg/(kg·d), group B consist of morphine 0.1 mg/(kg·d) and Ondansetron 0.08mg/(kg·d). And group C consist of fentanyl 8 μg/ (kg·d) and Ondansetron 0.08mg/ (kg·d). 50-100mg dolantin was intramuscular injected when required (VAS〉5) after operation in group A patients. Bloods amples were collected at the preoperative stage,the end of the operation and post-operative 6,24,48 hours for messure of β-EP. At the same moment MAP. HR, and SPO2 were recorded. Resttlts MAP, HR were perioperatively stable in group B and C,but were significantly higher postoperation than that preoperatively in group A. The β-EP level was no significantly difference among the three groups before operation. But it was significantly higher in group B and C than that in group A during the postoperation stage. Conclusion Intraveous lappaconitine for postoperative analgesia is effficient,and the side effects are slight.
Keywords:Morphine  Fentanyl  Ondansetron  Postoperation analgesia  β-EP
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