硬膜外吗啡镇痛对膀胱压的影响

目的　探讨硬膜外腔应用小剂量吗啡术后镇痛对膀胱压的影响。方法　选择联合腰麻硬膜外麻醉行开腹子宫手术的病人 2 7例 ,检测膀胱最大充盈状态下麻醉前及麻醉后 1、3、5小时的膀胱静态压、收缩压及其阻滞平面和排尿感恢复率。结果　麻醉前、后对照组和吗啡组的膀胱静态压基本不变 ;麻醉后膀胱收缩压均下降 ,术后 1小时降低明显 (P <0 0 5 )。术后 5小时吗啡组的膀胱收缩压恢复明显高于对照组 (P <0 0 5 )。术后 3小时、5小时对照组和吗啡组的膀胱排尿感恢复率分别为 33%和 30 %、10 0 %和 6 0 %。结论　硬膜外腔应用吗啡术后镇痛对膀胱收缩压无明显影响 ,而下腹部术后引起的尿潴留不排除与疼痛相关。

A clinical study on the effects of postoperative epidural analgesia with morphine on bladder pressure

Objective To evaluate the effects of postoperative epidural analgesia with a small dose of morphine on bladder pressure.Methods Twenty seven patients were scheduled for hysterectomy under combined spinal epidural anesthesia.After the maximized filling up,the bladder resting pressure and contracting pressure were measured before anesthesia,at 1h,3h and 5h after anesthesia.Blockade segments and recovery of urination were also observed after anesthesia at the same time points.Results The bladder resting pressure in control group and experimental group had no significant change before and after anesthesia.The bladder contracting pressure reduced after anesthesia.There was an obvious reduction in contracting pressure at 1h postoperatively ( P< 0 05). But compared to that in control group,the bladder contracting pressure in experimental group recovered at 5h postoperatively( P< 0 05).The urination recovery rates at 3h and 5h after operation in the control and experimental groups were 33% and 30%,100% and 60% respectively.Conclusions Morphine used for postoperative epidural analgesia has no effect on bladder contracting pressure.But the uroschesis after lower abdominal operation might be related to the pain.