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目的 评估低浓度纳络酮对患者自控硬膜外镇痛(PCEA)引起阿片类药副反应的影响 .方法 选在腰麻和硬膜外联合麻醉下行全子宫切除术后患者 15 0例 ,ASA ～ 级 ,随机分成 3组行 PCEA.A组 :芬太尼 (4 mg· L- 1 ) +布吡卡因 (0 .5 g· L- 1 ) +肾上腺素 (2 mg· L- 1 ) .B组 :A组 + (4mg· L- 1 )纳络酮 .C组 :A组 + (6 m g· L- 1 )纳络酮 .定时记录视觉模拟疼痛评分 (VAS) ,芬太尼用量 ,恶心、呕吐、皮肤瘙痒发生率及评分 .结果 3组芬太尼用量约为 0 .30 μg· kg- 1· h- 1 ,B,C两组纳络酮用量分别为 (0 .30± 0 .12 ) μg· kg- 1·h- 1 和 (0 .45± 0 .19)μg· kg- 1 · h- 1 ,2 4h内两种剂量纳络酮均可降低阿片类药副反应恶心、呕吐和皮肤瘙痒的发生率及评分 (P<0 .0 1) ,3组 2 4h内 VAS及芬太尼的用量相似 .结论 PCEA泵注芬太尼与布吡卡因 ,伍用纳络酮 (0 .3～0 .45μg· kg- 1 · h- 1 )既保证镇痛质量 ,又明显降低阿片类副反应发生率及评分
Objective To evaluate the effect of low concentration naloxone on opioid side effects caused by PCEA in patients undergoing total anesthesia.Methods Fifty patients undergoing total hysterectomy under spinal anesthesia and epidural anesthesia were enrolled and ASA The patients were randomly divided into 3 groups: PCEA group A: fentanyl (4 mg · L -1) + bupivacaine (0.5 g · L -1) + epinephrine (2 mg · L -1) Group B: naloxone in group A + (4mg · L-1), group C: naloxone in group A + (6 mg · L- 1), time-dependent visual analogue pain score (VAS), fentanyl dosage , Nausea and vomiting, the incidence of pruritus and scoring.Results The dosage of fentanyl in group 3 was about 0.30 μg · kg-1 · h-1, and the dosage of naloxone in group B and C were (0.30 ± 0.12) μg · kg-1 · h-1 and (0.45 ± 0.19) μg · kg-1 · h-1, two doses of naloxone could reduce opioid side effects within 24 hours Nausea, vomiting and pruritus incidence and score (P <0.01), 3 groups within 24 h of VAS and fentanyl in a similar amount.Conclusion PCEA pump fentanyl and bupivacaine, Wu Na satisfied Luokong (0 .3 ~ 0.45μg · kg-1 · h-1) not only ensure the quality of analgesia, but also significantly reduce opioids Reaction rates and scores