单剂量吗啡复合纳络酮在肛肠科患者术后镇痛中的应用

目的：探讨单剂量吗啡复合纳络酮用于肛肠科手术术后骶管内镇痛的疗效与副作用。方法：选择90例ASAⅠ-Ⅲ级择期行肛肠科手术的患者,随机分为N（吗啡0.08 mg/kg＋纳络酮0.002 mg/kg）组,R（吗啡0.08 mg/kg＋雷莫司琼0.3 mg）组和C（单用吗啡0.08 mg/kg）组,各组（30例）均加NS至15 mL。患者术中均采用腰硬联合麻醉方式,术毕经骶管腔内单次注射药物。观察术后4、8、12、24和48 h内各组视觉模拟评分（VAS）、恶心、呕吐、皮肤搔痒、排尿及呼吸抑制情况。结果：3组VAS无统计学意义;N、R组恶心、呕吐、皮肤搔痒明显轻于C组（P〈0.05）,N组排尿明显优于R、C组（P〈0.05）;3组均无呼吸抑制。结论：吗啡（0.08 mg/kg）合用纳络酮（0.002 mg/kg）可明显减轻肛肠术后的恶心、呕吐、皮肤搔痒等的吗啡副作用,同时又能促进早期排尿而不影响患者的镇痛效果。

Application of Single Dose Morphine Combined Naloxone in Anorectal Patients' Postoperation Analgesia

Objective：To investigate the analgesic efficacy and side effects of single dose morphine combined naloxone in anorectal patients＇ postoperation analgesia by sacral canal administration.Methods：Ninety ASA Ⅰ～Ⅲ patients with anorctal operation were randomly divided into N（morphine 0.08 mg/kg＋naloxone 0.002 mg/kg）,R（morphine 0.08 mg/kg＋ramosetron 0.3 mg）and C（morphine 0.08 mg/kg）groups.The visual analogus score（VAS）,nausea,vomiting,pruritus,urination and respiratory depression were recorded at 4,8,12,24 and 48 hours after operation.Results：There was no significant difference in VAS among groups.Compared with group C,the nausea,vomiting and pruritus were lower in N and R groups（P〈0.05）.Compared with R and C groups,the urination was better in group N（P〈0.05）,no respiratory depression was found in groups.Conclusion：Morphine 0.08 mg/kg combined with naloxone 0.002 mg/kg can reduce the side effects of nausea,vomiting and pruritus,but do not affect the analgesic efficacy in patients.