小剂量纳洛酮对吗啡PCEA镇痛效能及其副作用的影响

【目的】探讨不同剂量纳洛酮对吗啡硬膜外自控镇痛（PCEA）用于剖宫产妇镇痛效能及副作用的影响。方法]160例剖宫产术后镇痛患者随机分为4组，采用不同的药物进行PCEA。M组：吗啡7mg＋罗哌卡因150mg＋昂丹司琼8mg；MNl组：吗啡7mg＋罗哌卡因150mg＋纳洛酮0．25mg；MN2组：吗啡7mg＋罗哌卡因150mg＋纳洛酮0．40mg；MN3组：吗啡7mg＋罗哌卡因150mg＋纳洛酮0．55mg。各组均加盐水至100mL，在镇痛开始后48h内不同时间观察VAs疼痛评分、Ramsay’s评分、恶心呕吐、瘙痒、排气时间及呼吸抑制。结果]MN1组、MN2组和M组的VAS评分差异无显著性（P〉0．05）。MN3组的VAS评分则明显升高，与M组比较，MN1组的副作用发生率差异有显著性（P〈0．05），但MN2组与M组比较差异有显著性（P〈0．01）。【结论】7mg吗啡伍用0．40mg纳洛酮用于PCEA对吗啡镇痛效果无影响，并可有效地减少吗啡术后镇痛并发症。

Effect of Low Doses of Naloxone on the Analgesic Efficacy and Side Effects of Morphine PCEA

Objcctive]To explore the effect of low doses of naloxone on the analgesic efficacy and side effects of morphine PCEA in patients after caesarean section. Methods] One hundred and sixty ASA I -- 11 patients with caesarean section were randomly divided into four groups with different drugs for PCEA： group M （morphine 7mg ＋ ropivacaine 150mg ＋ ondansetron 8mg）, group MN1 （morphine 7mg ＋ ropivacaine 150mg ＋ naloxone 0. 25mg）, group MN2 （morphine 7mg ＋ ropivacaine 150mg ＋naloxone 0. 40mg） and group MN3 （morphine 7mg ＋ ropivacaine 150mg ＋ naloxone 0.55mg）. The Ramsay sedation score （RSS）, visual analog score（VAS）, the time of first flatus, and the incidence of pruritus, nausea, vomiting and respir- atory depression （respiratory rate〈6 bpm） were recorded at 4, 8, 12, 24 and 48 h after beginning of analgesia. Results]There was no significant difference in VAS among group MN1, MN2 and M, but VAS was lower in group MN3（P〈0.01）. Compared with group M, the side effects significantly decreased （P〈0.05） in group MN2（P〈0.01）. Conclusion]Naloxone 0.40mg may not only enhance the analgesic efficacy of mor-phine, but decrease side effects induced by morphine 7mg in PCEA.