不同剂量纳洛酮配合吗啡对老年患者术后静脉镇痛效能的影响

钱刚; 赵宏程; 李南; 张光明

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不同剂量纳洛酮配合吗啡对老年患者术后静脉镇痛效能的影响

钱刚 , 赵宏程 , 李南 , 张光明

文章导航 > 蚌埠医学院学报 > 2012, 36 > 3: (316-318)

引用本文:

Citation:

不同剂量纳洛酮配合吗啡对老年患者术后静脉镇痛效能的影响

1.
上海市长宁区中心医院麻醉手术科，200336

作者简介: 钱刚(1973-)，男，硕士，主治医师

通讯作者: 张光明, gmzhangyj@yahoo.com.cn

基金项目:

The influence of different dosages of naloxone on morphines postoperation analgesia efficiency in elder patients

1.
Department of Anesthesiology, Changning District Central Hospital, Shanghai 200336, China

Corresponding author: ZHANG Guang-ming, gmzhangyj@yahoo.com.cn

摘要: 目的：观察不同剂量纳洛酮配合吗啡对老年患者术后静脉镇痛效能的影响。方法：择期静吸复合全麻下接受腹部手术的老年患者120例，随机均分为4组。A组吗啡剂量为10gkg-1h-1，用生理盐水稀释至100 ml；B组在A组基础上加用纳洛酮0.1gkg-1h-1；C组在A组基础上加用纳洛酮0.2gkg-1h-1，；D组在A组基础上加用纳洛酮0.3gkg-1h-1。使用背景输注+患者自控镇痛模式：背景剂量为2 ml/h；患者自控镇痛：每次1 ml；锁定时间为15 min。记录镇痛开始后2、6、12、24、48 h视觉模拟评分(VAS)，评价镇痛效果，并记录术后恶心、呕吐、皮肤瘙痒、呼吸抑制等不良反应的发生情况。结果：A、B、C各组间VAS各时点镇痛效果差异均无统计学意义(P；0.05)，D组2、6、12、24、48 h VAS均显著高于A、B、C组同时点VAS(P；0.01)。B、C组6、12、24、48 h不良反应与D组2、6、12、24、48 h恶心呕吐评分和皮肤瘙痒评分均显著低于A组同时点(P；0.01)。4组均未发生呼吸抑制。结论：纳洛酮复合吗啡用于老年患者术后镇痛，可以有效地缓解恶心、呕吐、皮肤瘙痒等不良反应，当纳洛酮剂量达到0.3gkg-1h-1时对吗啡的镇痛效果有拮抗作用。
- 镇痛 /
- 吗啡 /
- 纳洛酮 /
- 不良反应
Abstract: Objective:To observe the influence of different dosages of naloxone on morphines postoperation analgesia efficiency in elder patients.Methods:One hundred and twenty elder patients who received intravenous-inhalation combined anesthesia for abdominal operation were randomly divided into 4 groups,30 in each group.Group A:morphines dosage was 10 gkg-1h-1,which was diluted by sodium chloride injection to 100 ml.Group B:0.1gkg-1h-1 dosage of naloxone was added on the base of group A.Group C:0.2 gkg-1h-1 dosage of naloxone was added on the base of group A.Group D:0.3gkg-1h-1 dosage of naloxone was added on the base of group A.Analgesia mode:background infusion(2 ml/h) with patient controlled analgesia(1 ml),lock out time 15 min.Pain visual analogue scale(VAS),nausea and vomiting,pruritus and breath depression were recorded at the time of 2,6,12,24 and 48 hours after analgesia was begun.Results:Analgesia efficiency:VAS was no statistical significances at the same time point between group A,B and C.VAS was raisen at the time of 2,6,12,24 and 48 hours after analgesia was begun in Group D compared with group A,B and C.There were significant differences(P0.01).The scores of nausea and vomiting,pruritus at the time of 6,12,24,48 hours in group B,C,D and at the time of 2 hours in group D were decreased compared with group A,there were significant differences(P0.01).No breath depression was recorded in group A,B,C and D.Conclusions:Naloxone combined with morphine in postoperation analgesia for elder patients can relief the nausea and vomiting,pruritus effectively.Naloxone at 0.3 gkg-1h-1 will resist the analgesia efficiency of morphine.
- analgesia /
- morphine /
- naloxone /
- adverse reaction

[2] 田海涛,师恩义,王祥丽.芬太尼混合小剂量纳洛酮用于老年患者术后静脉镇痛的可行性[J].临床麻醉学杂志,2006,22(8):599-600.
[2]	Bijur PE,Schechter C,Esses D,et al.Intravenous bolus of ultra-low-dose naloxone added to morphine does not enhance analgesia in emergency department patients[J].J Pain,2006,7(2):75-81.
[3] Jia DL,Ni C,Xu T,et al.A small-dose naloxone infusion alleviates nausea and sedation without impacting analgesia via intravenoustramadol[J].Chin Med J(Engl),2010,123(13):1695-1698.
[4] Crain SM,Shen KF.Antagonists of excitatory opioid receptor functions enhance morphines analgesic potency and attenuate opioid tolerance /dependence liability[J].Pain,2000,84(2/3):121-131.
[5] Greenwald PW,Provataris J,Coffey J,et al.Low-dose naloxone does not improve morphine-induced nausea,vomiting,or pruritus[J].Am J Emerg Med,2005,23(1):35-39.

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不同剂量纳洛酮配合吗啡对老年患者术后静脉镇痛效能的影响

通讯作者: 张光明, gmzhangyj@yahoo.com.cn

作者简介: 钱刚(1973-)，男，硕士，主治医师

1. 上海市长宁区中心医院麻醉手术科，200336

收稿日期: 2011-07-20
网络出版日期: 2012-03-15

基金项目:

关键词:

镇痛 /
吗啡 /
纳洛酮 /
不良反应

摘要: 目的：观察不同剂量纳洛酮配合吗啡对老年患者术后静脉镇痛效能的影响。方法：择期静吸复合全麻下接受腹部手术的老年患者120例，随机均分为4组。A组吗啡剂量为10gkg-1h-1，用生理盐水稀释至100 ml；B组在A组基础上加用纳洛酮0.1gkg-1h-1；C组在A组基础上加用纳洛酮0.2gkg-1h-1，；D组在A组基础上加用纳洛酮0.3gkg-1h-1。使用背景输注+患者自控镇痛模式：背景剂量为2 ml/h；患者自控镇痛：每次1 ml；锁定时间为15 min。记录镇痛开始后2、6、12、24、48 h视觉模拟评分(VAS)，评价镇痛效果，并记录术后恶心、呕吐、皮肤瘙痒、呼吸抑制等不良反应的发生情况。结果：A、B、C各组间VAS各时点镇痛效果差异均无统计学意义(P；0.05)，D组2、6、12、24、48 h VAS均显著高于A、B、C组同时点VAS(P；0.01)。B、C组6、12、24、48 h不良反应与D组2、6、12、24、48 h恶心呕吐评分和皮肤瘙痒评分均显著低于A组同时点(P；0.01)。4组均未发生呼吸抑制。结论：纳洛酮复合吗啡用于老年患者术后镇痛，可以有效地缓解恶心、呕吐、皮肤瘙痒等不良反应，当纳洛酮剂量达到0.3gkg-1h-1时对吗啡的镇痛效果有拮抗作用。

English Abstract

The influence of different dosages of naloxone on morphines postoperation analgesia efficiency in elder patients

Corresponding author: ZHANG Guang-ming, gmzhangyj@yahoo.com.cn

1. Department of Anesthesiology, Changning District Central Hospital, Shanghai 200336, China

Received Date: 2011-07-20
Available Online: 2012-03-15

Abstract: Objective:To observe the influence of different dosages of naloxone on morphines postoperation analgesia efficiency in elder patients.Methods:One hundred and twenty elder patients who received intravenous-inhalation combined anesthesia for abdominal operation were randomly divided into 4 groups,30 in each group.Group A:morphines dosage was 10 gkg-1h-1,which was diluted by sodium chloride injection to 100 ml.Group B:0.1gkg-1h-1 dosage of naloxone was added on the base of group A.Group C:0.2 gkg-1h-1 dosage of naloxone was added on the base of group A.Group D:0.3gkg-1h-1 dosage of naloxone was added on the base of group A.Analgesia mode:background infusion(2 ml/h) with patient controlled analgesia(1 ml),lock out time 15 min.Pain visual analogue scale(VAS),nausea and vomiting,pruritus and breath depression were recorded at the time of 2,6,12,24 and 48 hours after analgesia was begun.Results:Analgesia efficiency:VAS was no statistical significances at the same time point between group A,B and C.VAS was raisen at the time of 2,6,12,24 and 48 hours after analgesia was begun in Group D compared with group A,B and C.There were significant differences(P0.01).The scores of nausea and vomiting,pruritus at the time of 6,12,24,48 hours in group B,C,D and at the time of 2 hours in group D were decreased compared with group A,there were significant differences(P0.01).No breath depression was recorded in group A,B,C and D.Conclusions:Naloxone combined with morphine in postoperation analgesia for elder patients can relief the nausea and vomiting,pruritus effectively.Naloxone at 0.3 gkg-1h-1 will resist the analgesia efficiency of morphine.