本文選題：蛛網(wǎng)膜下腔 + 皮膚瘙癢��； 參考：《大連醫(yī)科大學(xué)》2014年碩士論文

【摘要】：目的：觀察術(shù)后間斷靜脈注射小劑量納洛酮（0.1mg）預(yù)防蛛網(wǎng)膜下腔應(yīng)用嗎啡鎮(zhèn)痛所致術(shù)后并發(fā)癥（惡心嘔吐、皮膚瘙癢、尿潴留）的臨床效果。 方法：選擇擇期短小的下肢及下腹部手術(shù)（闌尾炎11例，下肢骨折內(nèi)固定17例，下肢清創(chuàng)術(shù)5例，下肢取內(nèi)固定術(shù)27例，）60例，手術(shù)時間在2小時內(nèi)，ASAI～I(xiàn)I級，年齡20～40歲，麻醉方式為腰硬聯(lián)合阻滯。病人入室后，先建立輸注通路，再行腰3～4間隙穿刺，蛛網(wǎng)膜下腔注入0.5％重比重布比卡因10mg+嗎啡0.2mg共2.5ml，注藥速度0.2ml/s，硬膜外腔向頭側(cè)留置導(dǎo)管4cm。患者平臥后，調(diào)整體位以調(diào)節(jié)麻醉平面，使痛覺消失平面達(dá)T6～T8之間。若平面不夠，硬膜外腔給予適量2%利多卡因以維持平面。手術(shù)結(jié)束時，拔除硬膜外導(dǎo)管。所有病人術(shù)中均未留置導(dǎo)尿，術(shù)中出血量少于100ml，輸液量1000ml。病人術(shù)后隨機分為A、B兩組，A組每隔4h靜脈注射小劑量納洛酮0.1mg/4ml，B組注射同等劑量的生理鹽水。術(shù)后8小時內(nèi)不能排尿或出現(xiàn)尿潴留的患者按醫(yī)囑插入導(dǎo)尿管。惡心嘔吐嚴(yán)重患者的給于止吐藥，，托烷司瓊5mg靜注。監(jiān)測指標(biāo)：在術(shù)后8h和24h觀察記錄病人的疼痛視覺模擬評分（VAS）、瘙癢評分、惡心嘔吐次數(shù)、尿潴留發(fā)生率的發(fā)生情況，并觀察病人呼吸抑制情況（Sp0290%）。 結(jié)果：術(shù)后8h和24h的疼痛視覺模擬評分（VAS）A組為1.10±1.06和2.33±1.24，B組為1.27±1.12和1.97±1.47，兩組間比較無統(tǒng)計學(xué)差異(P0.05)。術(shù)后惡心嘔吐發(fā)生率、皮膚瘙癢發(fā)生率及尿潴留發(fā)生率，A組要明顯低于B組，組間比較差異有統(tǒng)計學(xué)意義(P0.05)。兩組病人均未發(fā)生呼吸抑制情況。 結(jié)論：蛛網(wǎng)膜下腔注射嗎啡行術(shù)后鎮(zhèn)痛用量少，能達(dá)到較好的鎮(zhèn)痛效果，但術(shù)后并發(fā)癥較多，如皮膚瘙癢，惡心嘔吐，尿潴留等。術(shù)后間斷靜注小劑量納洛酮0.1mg/4h不降低嗎啡鎮(zhèn)痛效果，同時卻能明顯減少其不良反應(yīng)，如皮膚瘙癢、惡心嘔吐發(fā)生率明顯減少，尿潴留發(fā)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 鹵1.06 and 2.33 鹵1.24 in group A and 1.27 鹵1.12 and 1.97 鹵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.
【學(xué)位授予單位】：大連醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2014
【分類號】：R614

【參考文獻(xiàn)】

相關(guān)期刊論文 前7條

1 袁智敏;金妤惠;趙建萍;李娜;;不同鎮(zhèn)痛方法用于婦科手術(shù)病人術(shù)后鎮(zhèn)痛的療效觀察[J];河南外科學(xué)雜志;2010年01期

2 邵兵,劉琴湘,郭訓(xùn),賴朝蓬,黃素清;蛛網(wǎng)膜下隙注射嗎啡術(shù)后鎮(zhèn)痛[J];臨床麻醉學(xué)雜志;2002年04期

3 賁智勇;;小劑量納洛酮對嗎啡自控鎮(zhèn)痛患者尿潴留發(fā)生率的影響[J];南通大學(xué)學(xué)報(醫(yī)學(xué)版);2010年03期

4 ;Effects of adenosine agonist R-phenylisopropyl-adenosine on halothane anesthesia and antinociception in rats[J];Acta Pharmacologica Sinica;2005年02期

5 秦承偉;張勵才;曾因明;;毀損大鼠中縫背核內(nèi)觸液神經(jīng)元對嗎啡依賴和戒斷的影響[J];中國應(yīng)用生理學(xué)雜志;2007年03期

6 車昊;張亞軍;;皮下注射納洛酮防止蛛網(wǎng)膜下腔嗎啡鎮(zhèn)痛引起皮膚瘙癢的臨床觀察[J];中日友好醫(yī)院學(xué)報;2009年02期

7 馮智英;;鞘內(nèi)藥物輸注鎮(zhèn)痛治療和管理—多學(xué)科專家共識[J];中國疼痛醫(yī)學(xué)雜志;2013年10期

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