吗啡与不同镇痛药联合使用对腹式子宫切除术后镇痛的效果

目的比较吗啡与不同镇痛药物联合应用于腹式子宫切除术后镇痛效果影响。方法择期ASAⅠ～Ⅱ级行腹式子宫切除术的患者60例,分为A、B、C3组(n=20):均在L2-3硬膜外麻醉下进行手术,A组于接受单次硬膜外注射吗啡0.5mg(4ml)单次硬膜外术后镇痛;B组接受单次硬膜外注射吗啡0.5mg(4ml)与鼻喷剂布托啡诺(1mg/0.1ml,q4h)联合镇痛;C组接受硬膜外术后吗啡(30mg·mL-1)-左旋布比卡因(1.125g.L-1)持续输注镇痛(2ml.h-1);记录VAS评分和医疗费用,观察血压、脉搏、呼吸、SPO2和有无延迟性呼吸抑制、恶心、呕吐、皮肤瘙痒等不良反应。结果 VAS评分比较,3组患者镇痛效果均达临床术后镇痛质控要求(各组36h内VAS评分均<4分),B组与C组的镇痛效果优于A组(P<0.05),但是B组与C组之间没有差异(P>0.05);术后镇痛医疗费用比较,C组>B组>A组。结论单次硬膜外注射吗啡0.5mg联合布托啡诺鼻喷剂(1mg,q4h)用于腹式子宫切除术后镇痛,其副作用少、镇痛效果确切、有助于提高医疗质量;在腹式子宫切除术后镇痛中推荐使用。

Comparison of postoperative analgesia between different protocols of epidural morphine in abdominal hysterectomy

Aim To compare the analgesic effect of three different protocols of epidural morphine following abdominal hysterectomy.Methods Sixty patients(ASA Ⅰ~Ⅱ)undergoing total abdominal hysterectomies were randomized into three groups(A,B and C,n=20 for each group).Following elective abdominal hysterectomy under epidural anesthesia via L2-3,the patients received a single epidural bolus of morphine(0.5 mg,4 ml)in group A,and a single bolus of morphine(0.5 mg)combined with transnasal butorphanol 1 mg(0.1 ml,q4h)in group B,and continuous epidural infusion with morphine(30 mg·L-1)-levobupivacaine(1.125 g·L-1)at the rate of 2 ml·h-1 in group C for postoperative analgesia.Parameters monitored were pain score(Visual Analogue Scale,VAS),medical expenditure,blood pressure,pulse,respiratory rate,SPO2;side effects such as nausea,emesis,skin itching and delayed respiratory depression were also assessed.Results From 20 h to 32 h during the epidural analgesia,the VAS scores in group B and C were lower than that in group A(P<0.05),howerer,there was no marked difference between group B and C.Correspongingly,there was a significant difference on medical expenditure among three groups(Group C>Group B>Group A,P<0.05).Conclusion Single epidural bolus of morphine 0.5 mg with regularly transnasal Butorphanol(1 mg,q4h)produced a better analgesic effect and less side effects in postoperative pain relief.It may be recommended for postoperative analgesia management of abdominal hysterectomy.