右美沙芬复合小剂量吗啡用于术后镇痛

[目的]观察不同剂量右美沙芬复合小剂量吗啡用于上腹部手术后镇痛的临床效果。[方法]择期全麻上腹部手术病人131例随机分为4组,即A组(吗啡30 mg 右美沙芬10 mg)、B组(吗啡30 mg 右美沙芬20 mg)、C组(对照组吗啡30 mg)、M组(吗啡50 mg),术后均使用100 ml一次性镇痛泵镇痛。记录术后3、6、24、48 h VAS、Ramsay镇静评分、活动后VAS评分和48 h内使用吗啡总量并记录可能出现的副作用。[结果]术后6、24 h M组、B组VAS明显低于对照(P<0．05),A组6 h明显低于对照(P<0．05)。活动后VAS在6、24 h吗啡与B组明显低于对照(P<0．05),而A组与对照差异无显著性(P<0．05),且在6 h显著高于M组(P<0．05)。各组术后镇静评分无差异(P<0．05)。术后48 h吗啡总量M组明显高于其他3组(P< 0．05),A、B组明显低于C(P<0．05)组。术后恶心呕吐病例吗啡组明显高于其他3组(P<0．05)。[结论]小剂量右美沙芬与吗啡联合应用可增加吗啡的镇痛效果,减少吗啡用量和副作用,发挥节约吗啡作用,并减少自身的副作用。

Clinical study on the effects of dextromethorphan combined with low dose morphine for postoperative and lgesia

[Objective] To compare the analgesic efficacy of different dose of dextromethorphan combined with low dose morphine after major abdominal surgery. [Methods] A total of 131 selective patients undergoing major abdominal surgery with general anesthesia were randomly divided into four groups: group A, B, C and M. In group A morphine 30 mg dextromethorphan 10 mg, group B morphine 30 mg dextromethorphan 20 mg, group C morphine 30 mg and group M morphine 50 mg were given intravenously. A sigle analgesia pump (100 ml) was used in all cases postoperatively. Visual analog scale at rest ( VAS) and after movement (VASM), sedation score (Ramsay) were recored 3, 6, 24, 48 hours postoperatively and frequency of opioid and NSAIDs side effects and morphine consumption were also recorded. [Results] There was a significant downward for VAS in M and B groups in 6 and 24 hours, and A group in 6 hours as that of compared with control (P < 0.05). The VASM scores were significantly lower in M and B groups in 6 and 24 hours (P < 0.05), but no difference between A and control (P<0.05), and a significantly higher than M group in 6 hours (P< 0.05). There was no difference of sedation score over time in all groups (P < 0.05). The mean 48 hour morphine requirements were significantly higher in M group than the others ( P < 0.05), and lower than control in group A and B (P < 0.05). More patients suffered from postoperative nausea and vomiting in M group as compared with that of the other three groups (P < 0.05), and no other side effects were observed. [Conclusion] Analgesia with low dose of dextromethorphan combined with morphine after major abdominal surgery significantly reduces morphine requirements and as- sociated side effects.