哌替啶联合异丙嗪在局麻下鼻内镜鼻窦手术中的应用

目的:观察哌替啶配伍异丙嗪在鼻窦内窥镜手术中的作用。方法:选择须行鼻内镜鼻窦手术的患者64例,随机分为观察组32例,对照组32例。观察组在局部麻醉完成后手术开始时肌注哌替啶100mg 异丙嗪50mg;对照组不用哌替啶 异丙嗪,病变严重程度及手术范围两组相同。结果:术中镇痛、镇静观察组效果较好,与对照组比较有差异(P<0.05),术中、术后观察组与对照组的平均动脉压和心率有差异(P<0.05)。结论:哌替啶配伍异丙嗪在鼻内窥镜手术中有良好效果,能显著改善患者的手术耐受性。     

Three neuroleptanalgesia schedules for laparoscopic sterilization by electrocoagulation

Women undergoing interval laparoscopic electrocoagulation sterilization were randomly assigned to one of three neuroleptanalgesia regimens. The 299 women received either morphine (10 mg)/droperidol (2.5 mg)/atropine (0.3 mg) or pethidine (100 mg)/droperidol (2.5 mg)/atropine (0.3 mg) or pethidine (100 mg)/droperidol (2.5 mg). A significantly higher proportion of anesthesia complications were recorded in the morphine group. The amount of pain experienced by the women was similar in the three groups, as were the rates of early follow-up complications and complaints. The neuroleptanalgesia regimen containing pethidine/droperidol/atropine appears to be the safest and most effective of the three considered here.     

Effect of acutely administered analgesic drugs on rat brain serotonin turnover

Rat brain 5-HT levels were unaltered by all four analgesics. Levels of 5-HAA in the rat brain were increased by morphine and decreased by pethidine. The effect of morphine, but not pethidine, on 5-HIAA levels was antagonized by naloxone pretreatment. Rat brain 5-HT turnover was measured by two non-isotopic techniques. Of morphine, pentazocine, methadone and pethidine only morphine increased brain 5-HT turnover. Furthermore, morphine increased brain tryptophan levels. The ability of morphine to increase both 5-HT turnover and tryptophan levels was antagonized by naloxone pretreatment. Pethidine also increased brain tryptophan levels but this effect was not antagonized by naloxone. It is concluded that the ability of morphine to increase rat brain 5-HT turnover is not possessed by pentazocine, methadone and pethidine.     

The influence of intrapartum opioid use on breastfeeding experience at 6 weeks post partum: A secondary analysis

ObjectiveTo examine breastfeeding experiences up to 6 weeks postpartum for mothers administered intranasal fentanyl, subcutaneous fentanyl or intramuscular pethidine for intrapartum analgesia.DesignA secondary analysis was undertaken using the per-protocol dataset to examine the third phase of a larger randomised controlled trial. This phase of the study examined breastfeeding intention and experience from the first hour of birth to 6 weeks postpartum. Medical records were audited and women were contacted at 6 weeks postpartum to complete a telephone questionnaire.SettingTwo maternity hospitals in South Australia.ParticipantsHealthy women birthing at term received intranasal fentanyl (n=37), subcutaneous fentanyl (n=37), or intramuscular pethidine (n=35).FindingsWhile maternal characteristics and birth outcomes were comparable between groups, women who received either intranasal fentanyl or subcutaneous fentanyl experienced fewer difficulties in establishing breastfeeding by 6 weeks postpartum when compared to intramuscular pethidine (p<0.01).Key conclusionsWomen who received fentanyl reported that their neonates had less difficulties establishing breastfeeding, compared to those who received pethidine. Therefore, for woman who intend to breastfeed, fentanyl should be the preferred opiate, for the relief of pain in labour.Implications for practiceWhen providing education to women in relation to intrapartum pain relief it is important to consider the potential influence on breastfeeding experience. This research provides evidence that fentanyl is a suitable alternative to pethidine for women requesting parenteral analgesia in labour.     

盆腔手术后镇痛效果的临床观察

目的比较盆腔手术后3种镇痛方法的疗效。方法选择拟行盆腔手术患者60例,其中子宫肌瘤40例,宫颈癌4例,卵巢囊肿16例。随机分为A组为对照组,术后根据需要肌注哌替啶;B组术后行硬膜外自控镇痛(PCEA)和C组术后行静脉自控镇痛(PCIA)。记录3组患者术毕、术后6h、12h及24h的VAS评分,MAP及HR。结果B组及C组术后各时点VAS评分、MAP及HR均较A组显著低(P<0.05或P<0.01)。结论术后自控镇痛技术用于盆腔手术后患者镇痛,疗效较肌注哌替啶好,且PCEA优于PCIA。     

曲马多对通气功能的影响

目的：了解曲马多作为麻醉辅助用药，对通气功能的影响。方法：将30例患者随机分成曲马多组(T组)和哌替啶组(P组)，采用曲马多2mg/kg(≤100mg／次)及哌替啶1mg/kg(≤50mg／次)，5分钟滴完后，观察其5、10、20、30分钟HR、SPO2、VT、VE及动脉血气分析各项指标。结果：P组与T组均有PaCo2轻度上升(P＞0，05)，P组VT、VE及SPO2短期下降明显并低于T组(P＜0．01)，而T组用药前后各参数无明显变化(P＞0．05)。结论：提示哌替啶有明显呼吸抑制作用，而曲马多麻醉期间辅助用药无进一步降低每分通气量之虑，但应注意用量及滴注速度。     

Estimation of infant dose and exposure to pethidine and norpethidine via breast milk following patient-controlled epidural pethidine for analgesia post caesarean delivery

Background

There is no information about the distribution of pethidine into breast milk and/or exposure of the breastfed infant during pethidine patient-controlled epidural analgesia after caesarean delivery.

Methods

We conducted an observational study among 20 women. The mean (95% confidence interval) pethidine dose administered was 670 (346-818) mg over 41 (35-46) h. Maternal plasma and milk and neonatal plasma were collected near the time of pethidine cessation and 6 h later. Absolute and relative infant doses via milk and infant exposure were calculated. Infant behaviour was assessed using the Neurologic and Adaptive Capacity Score.

Results

At first and second sampling times, mean absolute infant doses for pethidine were 20 (14-27) μg/kg/day and 10 (7-13) μg/kg/day, while mean relative infant doses were 0.7 (0.1-1.4)% and 0.3 (0.1-0.5)% respectively. Similar values for norpethidine (expressed as pethidine equivalents) were 21 (16-26) μg/kg/day and 22 (12-32) μg/kg/day; and 0.7 (0.3-1)% and 0.6 (0.2-1)% respectively. Mean pethidine and norpethidine concentrations in neonatal plasma were 3 (0-6.1) μg/L and 0.6 (0.2-1) μg/L. Compared with a time-matched maternal sample, the infant’s exposure was 1.4 (0.2-2.8)% for pethidine and 0.4 (0.2-0.6)% for norpethidine. The mean (95% confidence interval) neurologic and adaptive capacity score was 33.6 (32.2-34.9).

Conclusion

The combined absolute infant dose of pethidine and norpethidine received via milk was 1.8% of the neonatal therapeutic dose and the combined relative infant dose was below the 10% recommended safety level. Breastfed infants are at low risk of drug exposure when mothers self-administer epidural pethidine after caesarean delivery.     

酮咯酸氨丁三醇联合盐酸哌替啶治疗肾绞痛的临床观察

目的:观察酮咯酸氨丁三醇联合盐酸哌替啶治疗肾绞痛的临床疗效。方法:将我院2008年5月-2010年5月收治的中、重度疼痛的肾绞痛患者120例随机均分为3组,均采取肌肉注射药物进行镇痛治疗。其中,Ⅰ组应用酮咯酸氨丁三醇60mg;Ⅱ组应用盐酸哌替啶100mg;Ⅲ组应用酮咯酸氨丁三醇30mg+盐酸哌替啶50mg。记录用药前以及用药后3h内(0、0.5、1、1.5、2、2.5、3h)的疼痛强度、疼痛强度差、疼痛缓解度以判断镇痛效果,并观察各组治疗中的不良反应情况。结果:用药后,3组均在0.5h起效,在中度疼痛的镇痛方面,Ⅲ组在用药3h内的所有观察点均优于Ⅰ、Ⅱ组(P<0.05),在2h时差异最为显著(P<0.01);在重度疼痛的镇痛方面,Ⅲ组在用药1.5、2、2.5、3h时效果优于Ⅰ、Ⅱ组(P<0.05);Ⅲ组的中度以上疼痛缓解程度除0.5h外,其余各点与Ⅰ、Ⅱ组比较,差异均有统计学意义(P<0.05)。Ⅲ组不良反应的发生率小于其他2组(P<0.05)。结论:酮咯酸氨丁三醇联合盐酸哌替啶治疗肾绞痛效果显著,同时可减少盐酸哌替啶的使用量,并可延长镇痛时间,且安全性较好。     

氢化可的松和哌替啶对剖宫产蛛网膜下腔麻醉后寒战反应的疗效

目的：评价氢化可的松和哌替啶对椎管内麻醉后寒战的治疗作用。方法：选择剖宫产初产妇术后,Wrench分级2级及其2级以上患者80例,分为氢化可的松2.0mg/kg组、哌替啶0.05mg/kg组和生理盐水10ml组。术中监测心电图（ECG）、脉搏氧饱和度（SpO2）、血压（BP）、心率（HR）、肛温（T）。记录各组寒战发生时（T1）,寒战后10min（T2）、30min（T3）、60min（T4）体温,对以上4个时间点的寒战进行评分,并观察不良反应的发生情况。结果：3组患者术后随访发现,哌替啶组恶心、呕吐发生率较氢化可的松高（P〈0.05）。哌替啶组和氢化可的松组患者麻醉后寒战缓解迅速,寒战持续时间较短,症状较轻。结论：氢化可的松治疗麻醉后寒战较少引起恶心、呕吐等副作用,可用于剖宫产麻醉后寒战的治疗。