剖宫产术后鞘内注射不同剂量吗啡镇痛的疗效观察

目的探讨剖宫产术后鞘内注射不同剂量吗啡镇痛的效果及不良反应,优化吗啡鞘内注射的临床剂量。方法将我院96例行剖宫产的产妇随机分组,每组24例,患者均采用腰-硬联合麻醉(CESA)。鞘内注药:A组:0.5%的罗哌卡因15mg;B组:0.5%的罗哌卡因15mg+吗啡0.3mg;C组:0.5%的罗哌卡因15mg+吗啡0.6mg;D组:0.5%的罗哌卡因15mg+吗啡1.2mg。观察镇痛效果及不良反应。结果 B组、C组的VAS疼痛评分均显着高于A、D组,差异有统计学意义(P<0.05),在镇痛效果上C组与B组镇痛效果满意,C组在各时段均优于B组的镇痛作用。在不良反应上,吗啡用量越少,不良反应亦越少。结论鞘内注射吗啡镇痛用于剖宫产术,可减少局麻药用量,术后镇痛效果满意,不良反应少,是一种安全有效的术后镇痛方法。     

吗啡与芬太尼在剖宫产和妇科手术术后镇痛中的应用

目的对比吗啡与芬太尼用于剖宫产和妇科手术术后自控镇痛的效果和不良反应。方法选取50例剖宫产和50例妇科手术的患者,随机将两组患者分为吗啡组和芬太尼组,术后用硬膜外镇痛,采用视觉模拟分法,对两组患者的镇痛效果及不良反应进行比较。结果吗啡组镇痛效果优良率比较高,不良反应发生率妇科手术比产科高;芬太尼组镇痛效果妇科比产科好,不良反应发生率少。结论吗啡在产科手术术后镇痛效果满意效果,不良反应少;芬太尼在妇科手术术后镇痛效果满意,不良反应少,而吗啡在妇科手术术后镇痛恶心、呕吐、皮肤瘙痒、尿潴留等不良反应发生率高。     

布托啡诺与吗啡用于剖宫产术后静脉自控镇痛的效果比较

目的 比较布托啡诺与吗啡用于剖宫产术后产妇静脉自控镇痛(PCIA)的疗效及不良反应.方法 将80例择期行剖宫产术后的产妇,随机均分为布托啡诺组(B组)和吗啡组(M组),分别接受PCIA治疗.镇痛效果评价采用视觉模拟评分(VAS).结果 两组患者术后镇痛效果均良好.而B组的不良反应明显少于M组.结论 布托啡诺用于剖宫产术后PCIA可获得满意的镇痛效果,且不良反应低于吗啡.     

芬太尼与吗啡预充用于剖宫产术后硬膜外自控镇痛临床观察

剖宫产术后目前多采用硬膜外镇痛,将阿片类镇痛药与低浓度局部麻醉药联合持续硬膜外泵入镇痛效果确切[1],而在接镇痛泵前硬膜外给予小剂量吗啡负荷量预充可明显提高镇痛效果已被临床证实[2],但硬膜外应用吗啡易发生恶心呕吐、瘙痒及呼吸抑制等不良反应[3].本文旨在观察芬太尼能否取代吗啡作为剖宫产术后硬膜外镇痛的预充药,达到与吗啡相似的镇痛效果而减少不良反应.     

骶管腔内应用少量吗啡或吗啡氟哌啶合剂用于肛肠外科术后镇痛的临床观察

椎管腔内注少量吗啡用于术后镇痛,是目前被公认的镇痛方法之一。但是在镇痛同时也并发一些不良反应,近年来我院采用骶管腔内一次性注少量吗啡氟哌啶合剂用于肛门科术后镇痛,取得满意效果。报告如下。1 资料与方法1.1 一般资料:合剂组(吗啡、氟哌啶合剂)、吗啡各50例病人,均为肛门科手术。其中合剂组:肛瘘手术     

盐酸罗哌卡因用于剖宫产术后镇痛的效果观察

目的比较盐酸罗哌卡因复合吗啡与单用罗哌卡因行剖宫产术后硬膜外自控镇痛的效果。方法将行剖宫产术后镇痛的足月初产妇120例分为罗哌卡因复合吗啡组和单用罗哌卡因组各60例,比较两组镇痛效果、不良反应及对产妇术后恢复的影响。结果两组镇痛效果差异无统计学意义。罗哌卡因复合吗啡组产妇2、24、48小时的收缩压、舒张压及心率均低于罗哌卡因组,差异有统计学意义。罗哌卡因复合吗啡组不良反应发生率高于罗哌卡因组,差异有统计学意义。结论剖宫产术后用0.15%盐酸罗哌卡因行硬膜外自控镇痛效果好,不必复合吗啡,以免增加恶心、呕吐、皮肤瘙痒等不良反应。     

鞘内吗啡联合皮下自控术后镇痛的效果观察

目的:比较鞘内吗啡镇痛、皮下自控镇痛以及鞘内吗啡联合皮下自控镇痛在术后镇痛中的临床效果。方法:研究对象为300例行剖宫产术患者,ASA(美国麻醉医师协会)～级。随机分为鞘内吗啡镇痛组(A组)、皮下自控镇痛组(B组)和鞘内吗啡联合皮下自控镇痛组(C组),每组100例。A组鞘内吗啡0.6 mg,B组术终前接皮下自控镇痛泵,C组鞘内吗啡0.4 mg+皮下自控镇痛(镇痛泵于术后12 h开启)。记录三组术后4,8,12,24,48 h各时点疼痛视觉模拟评分法(VAS)和恶心、呕吐、皮肤瘙痒以及呼吸抑制等不良反应的发生情况。结果:术后8,12 h的VAS评分A组明显低于B组,术后24,48 h的VAS评分B组明显低于A组,C组的VAS评分于术后8,12 h明显低于B组,术后24,48 h明显低于A组。结论:鞘内吗啡、皮下自控镇痛均能产生良好的术后镇痛效果,将鞘内吗啡与皮下镇痛联合应用优于二者单独使用时的镇痛效果,并可减少各自用药量及不良反应的发生。     

吗啡缓释片辅以消炎痛栓用于剖宫产术后镇痛的分析

目的观察吗啡缓释片辅以消炎痛栓用于剖宫产术后镇痛效果。方法足月剖宫产孕妇98人随机分成2组,实验组术后予盐酸吗啡缓释片辅以消炎痛栓直肠给药镇痛,对照组采取连续硬膜外镇痛。观察术后镇痛效果、肛门排气时间、第一次下床活动时间、哺乳次数、不良反应等。结果两组产妇镇痛效果无明显差异,实验组肛门排气时间、第一次下床活动时间早于对照组,哺乳次数多,不良反应少。结论吗啡缓释片辅以消炎痛栓用于剖宫产术后镇痛作用有效,副作用小,有利于母乳喂养成功和产妇恢复。     

布托啡诺与吗啡在剖宫产术后硬膜外镇痛中的效果比较

吗啡类镇痛药用于剖宫产术后镇痛效果好,时间长,在临床上已经应用很广泛,但尿潴留、恶心、呕吐、皮肤瘙痒等不良反应发生较多.布托啡诺为完全人工合成的阿片受体激动拮抗药,主要通过对脊髓κ受体激动药和μ受体的部分激动药,能产生与吗啡类似的镇痛效果,但不良反应明显低于吗啡[1-7],因此,常用于替代吗啡控制术后急性疼痛.本研究拟通过比较布托啡诺和吗啡在剖宫产术后硬膜外镇痛的效果与不良反应,为临床选择应用提供依据.     

小剂量吗啡用于剖宫产术后硬膜外镇痛的临床观察

目的观察小剂量吗啡用于剖宫产术后硬膜外镇痛的临床效果及不良反应。方法2003年6月~2003年12月我院将剖宫产产妇216例分为观察组和对照组,两组均为连续硬膜外麻醉,手术结束时观察组将配有5 mg吗啡的自动连续输注镇痛泵接在硬膜外管上,术后观察镇痛效果及不良反应。结果与对照组比较观察组镇痛效果明显(P<0 05)。观察组呼吸抑制、肢体麻木与对照组比较,差异无显著性意义(P>0 05)。结论剖宫产术后硬膜外镇痛应用小剂量吗啡对产妇是安全有效的。     

Bremazocine: a kappa-opioid agonist with potent analgesic and other pharmacologic properties

Bremazocine is a kappa-opioid receptor agonist with potent analgesic and diuretic activities. As an analgesic it is three- to four-times more potent than morphine, as determined in both hot plate and tail flick tests. Bremazocine and other benzomorphan analogs were synthesized in an effort to produce opiates with greater kappa-opioid receptor selectivity and with minimal morphine-like side effects. Unlike morphine bremazocine is devoid of physical and psychological dependence liability in animal models and produces little or no respiratory depression. While bremazocine does not produce the characteristic euphoria associated with morphine and its abuse, it has been shown to induce dysphoria, a property that limits its clinical usefulness. Similarly to morphine, repeated administration of bremazocine leads to tolerance to its analgesic effect. It has been demonstrated that the marked diuretic effect of bremazocine is mediated primarily by the central nervous system. Because of its psychotomimetic side effects (disturbance in the perception of space and time, abnormal visual experience, disturbance in body image perception, de-personalization, de-realization and loss of self control) bremazocine has limited potential as a clinical analgesic. However, its possible utility for the therapy of alcohol and drug addiction warrants further consideration because of its ability to decrease ethanol and cocaine self-administration in non-human primates. In addition, the ability of bremazocine-like drugs to lower intraocular pressure and to minimize ischemic damage in animal models suggests their possible use in the therapy of glaucoma and cardiovascular disease.     

Role of morphine's metabolites in analgesia: Concepts and controversies

The metabolites of morphine, morphine-6-glucuronide (M6G) and morphine-3-glucuronide (M3G), have been extensively studied for their contribution to clinical effects following administration of morphine. Those contributions to both the desired effect (ie, analgesia) and the undesired effects (eg, nausea, respiratory depression) are the subject of clinical controversy. Much attention and effort have been directed at investigating the properties of M6G because of interest in this substance as a possible substitute for morphine. It exhibits increased potency and the possibility of a better side effect profile compared with morphine, although the reported relative benefits vary widely. M3G is not analgesic, but its role in producing side effects, including the development of clinical tolerance, has been proposed. This review is focused on M6G and the factors that contribute to its clinical utility. The formation and distribution of M6G are presented, as are the analgesic effect and the onset of this effect. The impact of genetics, age, and gender on M6G and its effects is also reviewed.     

舒芬太尼用于全髋置换手术后患者自控静脉镇痛35例

目的 观察舒芬太尼用于全髋置换手术后患者自控静脉镇痛的临床镇痛效果和不良反应.方法 选择全身麻醉下行全髋置换手术且进行自控静脉镇痛的患者70例,随机均分为两组.对照组使用0.5 g/L吗啡,试验组使用1.5μg/mL舒芬太尼,背景剂量2 mL/h,单次给药剂量1 mL,锁定时间8 min.观察患者术后2,8,24,48 h的镇痛效果,记录镇痛泵使用情况、不良反应以及是否使用其他镇痛药物.结果 试验组视觉模拟评分在术后48 h低于对照组(P<0.05);两组患者口述评分的差异无统计学意义(P>0.05);对照组有2例患者因镇痛不全而肌肉注射哌替啶50mg;两组患者恶心、呕吐的发生率比较无统计学差异(P>0.05),均未出现嗜睡、呼吸抑制等其他不良反应.结论 舒芬太尼可安全有效地用于全髋置换手术的患者自控静脉镇痛,镇痛作用确切且略优于吗啡,不良反应与吗啡相似.     

Lack of a rewarding effect and a locomotor-enhancing effect of the selective μ-opioid receptor agonist amidino-TAPA

Rationale and objectives

Psychological dependence is one of the worst side effects of morphine. It limits the clinical availability of morphine and non-patient morphine users suffer from addiction. An analgesic, which is more potent than morphine but without the liability of psychological dependence, has long been sought in the clinic. We have recently developed a new μ-opioid receptor agonist, N^α-amidino-Tyr-D-Arg-Phe-β-Ala (amidino-TAPA), as a potent analgesic with an antinociceptive profile that is distinct from morphine, including the release of endogenous κ-opioid peptides. The activation of κ-opioid receptors has been suggested to suppress the development of psychological dependence by μ-opioid receptor agonists. In the present study, the psychological dependence liability and the related locomotor-enhancing effect of amidino-TAPA were evaluated.

Results

Amidino-TAPA injected subcutaneously produced an extremely potent and longer lasting antinociception than morphine in ddY mice, prodynorphin-knockout mice, and wild-type C57BL/6J mice. Unlike subcutaneously injected morphine, which had potent locomotor-enhancing and rewarding effects at antinociceptive doses in ddY mice, amidino-TAPA injected subcutaneously did not induce significant locomotor-enhancing and rewarding effects at antinociceptive or even higher doses in ddY mice. In wild-type C57BL/6J mice, amidino-TAPA showed the same pharmacological profile (potent antinociception, lack of locomotor-enhancing and rewarding effects) as in ddY mice. However, amidino-TAPA produced potent locomotor-enhancing and rewarding effects at antinociceptive doses in prodynorphin-knockout mice.

Conclusions

The present results suggest that amidino-TAPA is a potent analgesic without the liability of psychological dependence because it releases endogenous κ-opioid peptides.     

氟比洛芬酯复合布托啡诺、吗啡用于晚期癌症患者自控镇痛

目的观察晚期癌症患者自控静脉镇痛（patient-controlled intravenous analgesia,PCIA）中氟比洛芬酯复合布托啡诺、吗啡的镇痛效果。方法 40例Ⅱ~Ⅲ级晚期癌症患者应用PCIA镇痛,分为两组：氟比洛芬酯＋布托啡诺组（B组）、氟比洛芬酯＋吗啡组（M组）,观察48h内（6h,12h,24h,48h）的镇痛、镇静评分及不良反应发生情况。结果 48h内的VAS评分和镇静评分,两组间无显著差异（P〉0.05）,B组患者不良反应的发生率明显少于M组。结论氟比洛芬酯复合布托啡诺用于晚期癌症自控镇痛的效果良好,且不良反应低于吗啡。     

Morphine-6-glucuronide: potency and safety compared with morphine

Background: In contemporary medicine, morphine remains the drug of choice in the treatment of severe postoperative pain. Nevertheless, morphine has several side effects, which can seriously compromise its analgesic effectiveness and the patient safety/compliance. The search for opioid analgesics with a better side-effect profile than morphine has led to a morphine metabolites, morphine-6-glucuronide (M6G). Objective: The objectives of the current paper are to give an overview of the analgesic properties of M6G, assess the dose range at which it produces equianalgesia to morphine and explore its side-effect profile. Methods: A review of published clinical studies (Phase II – III) on M6G in the treatment of experimental and clinical pain is given. Results/conclusions: M6G > 0.2 mg/kg is an effective analgesic with a slower onset but longer duration of action (> 12 h) compared with morphine. Side effects, most importantly postoperative nausea and vomiting, occur less frequent after M6G treatment. M6G is an attractive alternative to morphine in the treatment of severe postoperative pain.     

The analgesic action of d-phenylalanine in combination with morphine or methadone]

The analgesic action of D-phenylalanine (D-Phe) is well known. It has been demonstrated in hot-plate tests on mice that combining D-Phe with narcotic analgesics already with doses inactive on separate application. In combination with D-Phe, a dose of morphine less by half compared to its unique use does not reduce analgesic activity in rats, but after six weeks of treatment some undesirable side effects like dependence, behavioural disorders and growth retardation are markedly lowered. These results suggest the possibility to design a combined drug similarly effective as well-introduced narcotic analgesics, but better tolerated.     

丙帕他莫复合吗啡自控静脉镇痛用于开腹结肠癌根治术后的镇痛效果

目的观察丙帕他莫复合吗啡自控静脉镇痛（PCIA）用于开腹结肠癌根治术患者术后镇痛的效果及安全性。方法 80例ASAⅠ或Ⅱ级行结肠癌根治术患者随机分为两组,吗啡组（M组）和丙帕他莫复合吗啡组（P组）。术毕均给与静脉自控镇痛（PCIA）,镇痛药物吗啡1mg/mL,镇痛方案：负荷量1mL,维持量0.5mL/h,追加量1mL,锁定时间5min。P组手术结束前30min、之后12、24、36h分别静脉滴注丙帕他莫2g,M组相同时间点给予等容量生理盐水。两组均镇痛至术后48h。记录术后12、24、36和48h安静和咳嗽VAS评分,镇静Ramsay评分及镇痛期间不良反应发生率,记录PCA总按压次数、有效按压次数及吗啡用量。结果两组患者各时点VAS评分无差异。与M组比较,P组Ramsay评分、PCA总按压次数、有效按压次数、吗啡用量、不良反应发生率降低（P〈0.05）。结论丙帕他莫复合吗啡自控静脉镇痛用于开腹结肠癌根治术患者术后镇痛的效果较好,不良反应发生率低。     

Behavioral effects of morphine, levorphanol, dextrorphan and naloxone in the frog Rana pipiens

Systemic morphine induces explosive motor behavior and generalized muscular rigidity in frogs. Naloxone does not reverse either of these effects of morphine but at high doses causes muscular flaccidity and unresponsiveness to stimulation. Intraspinal morphine induces rigidity, but not explosive motor behavior, and this action is blocked by naloxone. Behavioral effects are seen rarely after intraspinal levorphanol (rigidity) and never after intraspinal dextrorphan or naloxone. In contrast to systemic morphine and naloxone, systemic levorphanol and dextrorphan are lethal to frogs at high doses.     

吗啡联合小剂量阿片受体拮抗剂应用研究进展

吗啡是临床常用的强效阿片类镇痛药，临床应用中出现恶心、呕吐、镇静、瘙痒、便秘、尿潴留、呼吸抑制等副作用，长期应用又出现耐受和依赖。大剂量阿片受体拮抗剂能拮抗吗啡所产生的全部效应，而小剂量的阿片受体拮抗剂不仅能减少或减轻吗啡所致的副作用，还能增强吗啡的镇痛效能。本文就小剂量阿片受体拮抗剂与吗啡的联合应用、小剂量阿片受体拮抗剂增强吗啡镇痛效能、减弱吗啡耐受和依赖的作用机制，以及拮抗副作用等方面的研究进展进行综述。