小剂量纳洛酮预防蛛网膜下腔吗啡所致术后并发症的临床观察

发布时间：2018-06-09 06:31

本文选题：蛛网膜下腔 + 皮肤瘙痒　；参考：《大连医科大学》2014年硕士论文

【摘要】：目的：观察术后间断静脉注射小剂量纳洛酮（0.1mg）预防蛛网膜下腔应用吗啡镇痛所致术后并发症（恶心呕吐、皮肤瘙痒、尿潴留）的临床效果。方法：选择择期短小的下肢及下腹部手术（阑尾炎11例，下肢骨折内固定17例，下肢清创术5例，下肢取内固定术27例，）60例，手术时间在2小时内，ASAI～II级，年龄20～40岁，麻醉方式为腰硬联合阻滞。病人入室后，先建立输注通路，再行腰3～4间隙穿刺，蛛网膜下腔注入0.5％重比重布比卡因10mg+吗啡0.2mg共2.5ml，注药速度0.2ml/s，硬膜外腔向头侧留置导管4cm。患者平卧后，调整体位以调节麻醉平面，使痛觉消失平面达T6～T8之间。若平面不够，硬膜外腔给予适量2%利多卡因以维持平面。手术结束时，拔除硬膜外导管。所有病人术中均未留置导尿，术中出血量少于100ml，输液量1000ml。病人术后随机分为A、B两组，A组每隔4h静脉注射小剂量纳洛酮0.1mg/4ml，B组注射同等剂量的生理盐水。术后8小时内不能排尿或出现尿潴留的患者按医嘱插入导尿管。恶心呕吐严重患者的给于止吐药，，托烷司琼5mg静注。监测指标：在术后8h和24h观察记录病人的疼痛视觉模拟评分（VAS）、瘙痒评分、恶心呕吐次数、尿潴留发生率的发生情况，并观察病人呼吸抑制情况（Sp0290%）。结果：术后8h和24h的疼痛视觉模拟评分（VAS）A组为1.10±1.06和2.33±1.24，B组为1.27±1.12和1.97±1.47，两组间比较无统计学差异(P0.05)。术后恶心呕吐发生率、皮肤瘙痒发生率及尿潴留发生率，A组要明显低于B组，组间比较差异有统计学意义(P0.05)。两组病人均未发生呼吸抑制情况。结论：蛛网膜下腔注射吗啡行术后镇痛用量少，能达到较好的镇痛效果，但术后并发症较多，如皮肤瘙痒，恶心呕吐，尿潴留等。术后间断静注小剂量纳洛酮0.1mg/4h不降低吗啡镇痛效果，同时却能明显减少其不良反应，如皮肤瘙痒、恶心呕吐发生率明显减少，尿潴留发生率低。
[Abstract]:Objective: to observe the prevention of postoperative complications (nausea and vomiting, pruritus) caused by subarachnoid morphine analgesia by intermittent intravenous injection of naloxone (0.1 mg). Methods: 11 cases of appendicitis, 17 cases of internal fixation of lower extremity fracture, 5 cases of debridement of lower extremity and 60 cases of internal fixation of lower extremity were selected. The age was 20 to 40 years old, and the anesthesia was combined spinal-epidural block. After the patient entered the room, the infusion pathway was established first, and then the puncture was performed on the 4th space of the lumbar spine. The subarachnoid cavity was injected with 0.5% bupivacaine 10mg morphine (2.5 ml) at a rate of 0.2 ml / s, and the epidural cavity was indwelling to the cephalic side for 4 cm. After supine, adjust the position to adjust the anaesthesia level and make the pain disappear between T 6 and T 8. If the plane is not enough, epidural administration of appropriate amount of 2% lidocaine to maintain the plane. At the end of the operation, the epidural catheter was removed. No catheterization was retained in all patients. The blood loss was less than 100 ml and the infusion volume was 1000 ml. The patients were randomly divided into two groups: group A: small dose naloxone 0.1 mg / L / 4 ml / L every 4 h. Group B was given the same dose of normal saline. Patients who are unable to urinate or have urinary retention within 8 hours after operation are required to be inserted into the catheter. In patients with severe nausea and vomiting, tropisetron 5mg was given antiemetic drugs. Monitoring measures: visual analogue score of pain, itching score, number of nausea and vomiting, incidence of urinary retention were observed and recorded at 8 hours and 24 hours after operation. Results: the visual analogue scores of pain were 1.10 卤1.06 and 2.33 卤1.24 in group A and 1.27 卤1.12 and 1.97 卤1.47 in group B, respectively. Results: there was no significant difference between the two groups. The incidence of nausea and vomiting, pruritus and urinary retention in group A was significantly lower than that in group B (P 0.05). Conclusion: subarachnoid injection of morphine for postoperative analgesia can achieve a better analgesic effect, but there are many postoperative complications, such as pruritus, nausea and vomiting, urine retention and so on. Intermittent intravenous injection of naloxone 0.1mg/4h did not decrease the analgesic effect of morphine, but significantly reduced the adverse reactions, such as pruritus, nausea and vomiting, and low incidence of urinary retention.
【学位授予单位】：大连医科大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R614

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