不同剂量纳洛酮对术后舒芬太尼镇痛的影响

目的:观察不同剂量纳洛酮对术后采用患者静脉自控镇痛(patient-controlled intravenous analgesia,PCIA)方式给予舒芬太尼的镇痛效果的影响及对患者术后恶心呕吐的影响。方法:选择美国麻醉医师协会(American Society of Anesthesiologists,ASA)分级Ⅰ~Ⅱ级、在全身麻醉联合硬膜外麻醉下行全子宫或者全子宫加双附件切除术的患者100例,按照随机数字表将患者随机分为C组、N1组、N2组、N3组,每组25例。C组硬膜外注射0.9%氯化钠液4 mL,N1、N2、N3组分别硬膜外注射5、10、20μg/mL的纳络酮4 mL,静脉注射舒芬太尼0.1μg/kg作为负荷剂量的镇痛药物后应用舒芬太尼静脉镇痛泵(4mL/h)。手术后6、12、24 h观察患者的视觉模拟评分(visual analogue scale,VAS)及恶心呕吐评分等不良反应。结果:(1)与C组比较,N1组术后6、12 h内静息和活动时的VAS评分均较低(P0.05),N3组术后6 h内静息和活动时的VAS评分较高(P0.05)。N2组与C组比较差异无统计学意义(P0.05)。N2组、N3组术后6、12 h内静息和活动时的VAS评分明显高于N1组(P0.05/0.01);(2)与C组比较,N1组、N2组、N3组恶心或呕吐发生率较低(P0.05),恶心或呕吐的评分较低(P0.05/0.01)。与C组比较,N1组、N2组、N3组观察期间需要应用昂丹斯琼的患者例数较少(P0.05)。4组患者均无其他不良事件发生。结论:硬膜外应用小剂量纳络酮可以有效地减少术后舒芬太尼PCIA所引起的恶心呕吐,5μg/mL的纳络酮同时还可增强舒芬太尼的镇痛效能。

Effects of Different Doses of Naloxone on the Postoperative Analgesia Potency of Sufentanil

Objective：To observe the effect of different doses of naloxone on the postoperative analgesic potency of sufentanil in patient-controlled intravenous analgesia（PCIA） and postoperative nausea and vomiting（PONV）： Methods：A total of 100 female patients who received hysterectomy or hysterectomy with adnexectomy under general anesthesia combined with epidural block anesthesia and whose American Society of Anesthesiologists （ASA） grades were Ⅰ-Ⅱ were randomly divided into 4 groups by random number table, with 25 patients in each group. Before sufentanil 0.4μg/kg was administered for intravenous analgesia, the patients in Group C received epidurally 0.9 % NaCl 4 mL, while Group N1, Group N2, Group N3 received epidurally 5,10, 20 μg/mL naloxone. At 6,12,24 h after operation, visual analogue scale（VAS） score, PONV etc were recorded by double blind method. Results： （1） The VAS scores at rest and movement in Group N1 were obviously lower than those in Group C at 6,12 h after operation（P〈0.05）. The VAS scores at rest and movement in Group N3 were obviously higher than those in Group C at 6 h after operation（P〈0.05）. The VAS scores at rest and movement in Group N2 and Group C had no differences （P〈 0.05）. The VAS scores at rest and movement in Group N2 and Group N3 were obviously higher than those in Group N1 at 6, 12 h after operation （P〈0.05）; （2）The rates of nausea and vomiting in Group N1, Group N2, Group N3 were lower than those in Group C（P〈0.05）. The cases in Group N1, Group N2, Group N3 needed ondansetron for treatment of PONV were less than those in Group C（P〈0.05）. There were no other adverse events in the four groups. Conclusions： Epidural injection of low-dose of naloxone can alleviate nausea and vomiting caused by postoperative administration of sufentanil in PCIA. Naloxone 5 μg/mL can enhance the analgesic potency of sufentanil.