小剂量纳洛酮在芬太尼静脉自控镇痛中的应用

目的对比芬太尼静脉自控镇痛（PCIA）泵中分别加入小剂量纳洛酮和昂丹司琼对患者恶心呕吐发生率及镇痛效果的影响,寻找更有效防止恶心呕吐的配伍方式。方法选取60例择期于静脉复合全麻下行腹部手术的患者,随机分为3组,N组（纳洛酮组,20例）：纳洛酮＋芬太尼;O组（昂丹司琼组,20例）：昂丹司琼＋芬太尼;C组（对照组,20例）：芬太尼。评估24 h内患者恶心呕吐的发生率,以及2、6、12、24、48 h内疼痛最明显时的视觉模拟评分（VAS）。结果 3组总恶心呕吐发生率比较差异有统计学意义（P〈0.05）;N组的总恶心呕吐发生率明显低于C组和O组（P＇〈0.0125）;重度恶心呕吐发生率N组明显低于C组（P＇〈0.0125）,N组与O组及O组与C组间差异无统计学意义（P＇均〉0.0125）。VAS评分N组在6 h明显低于C组（P〈0.05）;在O组和C组间差异无统计学意义（P〉0.05）。结论与昂丹司琼比较,小剂量纳洛酮应用于芬太尼PCIA可明显降低患者恶心呕吐的发生率,同时可增强芬太尼的镇痛效果。

Combination of fentanyl with low-dose naloxone for patient-controlled intravenous analgesia

Objective To find out a more effective drug compatibility method in preventing nausea and vomiting for patient-controlled intravenous analgesia（PCIA） by comparing the rate of nausea,vomiting,and analgesic effect of fentanyl in combination with low-dose naloxone or ondansetron. Methods Sixty patients underwent elective abdominal operations and received a standardized general anaesthesia were randomly divided into 3 groups： naloxone group（naloxone combined with fentanyl,n=20）,ondansetron group（ondansetron combined with fentanyl,n=20）and control group（ fentanyl alone,n=20）. The rate of nausea and vomiting of patients in 24h,and visual analogue scale（ VAS） for pain was evaluated in 2,6,12,24,48h after the operation. Results The total rate of nausea and vomiting was different in three groups（P0.05）. The incidence of total nausea and vomiting in naloxone group was significantly lower than that in control group and ondansetron group（all P＇0.0125）. The incidence of severe nausea and vomiting in naloxone group was also significantly lower than that in control group（P＇0.0125）,but there were no difference among naloxone group and ondansetron group as well as ondansetron group and control group. VAS score of naloxone group was significantly lower than control group（P0.05）,and there was no statistically significant difference of VAS score between ondansetron and control group（P0.05） 6 h after the operation. Conclusions Compared with ondansetron,low-dose naloxone combined fentanyl for PCIA can not only reduce the rate of nausea and vomiting,but also enhance the analgesic effect of fentanyl.