布托啡诺联合恩丹西酮在直肠癌根治术后硬膜外吗啡镇痛中的抗瘙痒以及抗恶心呕吐作用

目的：考察术前联合应用恩丹西酮和布托啡诺,对接受硬膜外吗啡镇痛患者术后瘙痒及恶心呕吐的预防作用是否优于单药应用。方法：选择限期直肠癌根治手术的患者120例,随机分为4组。依据分组,手术消毒时,组1患者硬膜外注入吗啡2mg＋0.9%氯化钠液（共5mL）,组2硬膜外注入吗啡2mg＋布托啡诺1mg＋0.9%氯化钠液（共5mL）,组3硬膜外注入吗啡2mg＋0.9%氯化钠液（共5mL）,同时静脉给予恩丹西酮8mg,组4硬膜外注入吗啡2mg＋布托啡诺1mg＋0.9%氯化钠液（共5mL）,同时静脉给予恩丹西酮8mg。术后予患者自控硬膜卡镇痛（PCEA）持续镇痛,评定患者术后48h内的视觉模拟疼痛（VAS评分）、舒适度（BCS评分）、镇静（Ramesay评分）以及瘙痒、恶心呕吐的发生情况。结果：4组患者之间VAS、BCS及Ramesay评分均无显著差异（P〉0.05）,但组2,组3,组4出现需要治疗的瘙痒及恶心呕吐的发生率显著低于组1（P〈0.05）;另外,组4患者恶心呕吐的发生率显著低于组2（P〈0.05）,而且组4患者瘙痒的发生率显著低于组3（P〈0.05）。结论：布托啡诺联合恩丹西酮在不影响吗啡镇痛效果的同时,可以显著减少直肠癌患者根治术后恶心呕吐以及瘙痒的发生率,其效果明显优于单独用布托啡诺或者恩丹西酮,从而提高患者的满意度。

Butorphanol plus Ondansetron as Prophylactic Antiemetic and Antipruritic Therapy in Patients Receiving Intrathecal Morphine for Radical Resection of Rectal Carcinoma

Objective：To observe whether the administration of ondansetron and butorphanol preoperatively could provide better antiemetic and antipruritic effects than mono-therapy in patients receiving epidural anesthesia with morphine.Methods： A total of 120 patients undergoing radical resection of rectal carcinoma were randomized four groups.In Group I,the patients received 2mg morphine（in 5 ml saline） epidurally;In Group II,the patients received 2mg morphine and 1mg butorphanol（in 5 ml saline） epidurally;In Group III,the patients received 2mg morphine（in 5 ml saline） epidurally and 8mg ondansetron intravenously;While in Group IV,the patients received 2mg morphine and 1mg butorphanol（in 5 ml saline） epidurally and 8mg ondansetron intravenously.Postoperatively,patient-controlled epidural analgesia was kept for 48 hours,during which visual analogue scale（VAS） score,Bruggman comfort score（BCS） score,Ramesay score and the incidence of postoperative nausea and vomiting（PONV） and pruritus for each patient were recorded.Results： There was no significant difference among the four groups in regard to VAS score,BCS score and Ramesay score（P0.05）.The incidence of PONV and pruritus in Group II,III and IV were lower than those in Group I（P0.05）.Further more,the incidence of PONV in Group Ⅳ was significantly lower than that of Group II（P0.05）,and the incidence of pruritus in Group IV was significantly lower than that of Group III（P0.05）.Conclusions： We concluded that compared with ondansetron or Butorphanol alone,the combination of Butorphanol and ondansetron could reduce the incidence of PONV and pruritus without affecting the analgesic effect of morphine.