芬太尼静脉镇痛对血浆胃动素的影响

目的　研究芬太尼静脉镇痛对血浆胃动素水平的影响。方法　接受矫形外科手术的ASAI～II级患者 5 0例 ,随机分为哌替啶镇痛组 (P组即对照组 ,n =2 0 )和芬太尼静脉镇痛组(F组 ,n =30 )。镇痛方式 :F组采用病人自控静脉镇痛 (PCIA) ,配方 :芬太尼 1 2mg、氟哌利多 5mg,加生理盐水至 10 0ml。背景流量 2ml/h ,自控剂量 0 5ml,锁定时间 15min。P组采用肌注哌替啶镇痛。分别于手术当天、术后第 1、2和 3天晨抽取空腹静脉血 2ml,放免法测定胃动素含量。观察指标 :镇痛评分、恶心呕吐评分和镇痛药用量。结果　F组镇痛效果显著优于P组 (P <0 0 1)。术后第 1天两组血浆胃动素水平均显著下降 (P <0 0 1) ,但两组间比较无显著差异 (P >0 0 5 )。F组第 2天胃动素水平显著上升 (与基础值相比 ,P <0 0 1;与P组相比 ,P <0 0 1) ,第 3天逐渐下降。有 11例患者发生恶心呕吐。P组第 2、3天胃动素水平逐渐上升 ,接近术前水平 ,3例患者出现恶心呕吐。结论　芬太尼静脉镇痛升高血浆胃动素水平 ,可能是芬太尼静脉镇痛增加术后恶心呕吐的机制

Effect of fentanyl intravenous analgesia on plasma motilin level

Objective To determine the effect of fentanyl intravenous analgesia on plasma motilin levels.Methods A total of 50 orthopedic patients were included in this randomized controlled study and were divided into two groups randomizely.The traditional meperidine group(n=20, group P) and fentanyl intravenous analgesia group(PCIA,group F, n=30).Plasma motilin concentrations were measured by RIA.Results The basic level of motilin was similar in both groups (P>0.05).At the first postoperative day, plasma motilin reduced significantly(P<0.01)in both groups. At the second day, the plasma motilin level increased significantly in group F(compared with basic level, P<0.01,compared with group P, P<0.01)and reduced gradually in the third day, which is consistent with the higher incidence of postoperative nausea and vomiting in two groups(36.7% vs 15%).Conclusion Fentanyl intravenous analgesia increases plasma motilin level, which may be one of the mechanisms behind the higher incidence of postoperative nausea and vomiting associated with PCIA.