摘要
目的探讨冠脉搭桥术(CABG)病人红细胞包蔽吗啡溶液(RBC-M)术后镇痛的可行性。方法拟行CABG术的病人50例,随机分为RBC-M组和PCA组,每组25例。拔除气管导管后2 h, RBC-M组给予新鲜配制的RBC-M溶液,剂量为0.14mg/kg;PCA组用0.01%的吗啡进行病人自控静脉镇痛,负荷量2ml,bolus量1 ml,背景输注速率1 ml/h,4 h限量为15 ml,锁定时间10 min。分别于术前、镇痛前及镇痛开始后1、2、3、8、12、24、36、48 h时对病人疼痛、镇静与舒适状态进行评分。持续观察心率(HR)、平均动脉压(MAP)、呼吸频率(RR)和动脉血气;镇痛前后不同时点测定RBC-M组吗啡血清浓度;记录并发症、吗啡用量。结果与PCA组比较,RBC-M组在镇痛开始后2 h内疼痛评分降低,镇静评分升高,HR和RR降低,PaCO2升高;镇痛开始后的24 h内舒适评分升高,镇静评分降低;吗啡用量降低(P<0.05或0.01),恶心、呕吐发生率差异无统计学意义(P>0.05)。RBC-M溶液的药代动力学模型为二室模型,半衰期为15.37 h,清除率为2.1 ml·kg-1·min-1,稳态表观分布容积为0.088 L/kg, 血药浓度时间曲线下面积为7 911.6 ng·ml-1·h-1。结论CABG病人RBC-M进行术后镇痛是安全、有效的。
Objective To investigate the feasibility of using intact erythrocytes obtained from patients＇own blood as morphine carrier （RBC-M solution） for postoperative analgesia in patients undergoing coronary artery bypass grafting （CABG）. Methods Fifty ASA Ⅰ-Ⅲ patients undergoing CABG were randomized to receive RBC-M solution or morphine PCIA （ n = 25 each）. In RBC-M group the patients received a bolus of RBC-M solution containing morphine 0.14 mg · kg^-1 infused slowly i.v. at 2 h after tracheal extubation. If the patients felt intolerable pain additional morphine 10 mg was given intramuscularly. In morphine PCIA group the patients received intravenous plain morphine 0.01% via a PCA device （loading dose 2 mg, background infusion 1 mg·h^-1 , bolus 1 mg, lockout time 10 rain, 4 h-total dose limit 15 mg） at 2 h after tracheal extubation. MAP, HR,and RR were continuously monitored. VAS, sedation and comfort scores were recorded and arterial blood samples were taken for blood gas analysis and determination of plasma morphine concentration at 2,5,10,20,30,1, 2,4,8, 12, 24, 36 and 48 h after operation. Total morphine consumption and the side effects were recorded. Results （ 1 ） During the first 2 h RBC-M solution provided better analgesia with lower HR , and RR but higher PaCO2 than morphine PCIA. During the first 24 h higher comfort scores （ better comfort） but lower sedation scores （ less sedated） were recorded in RBC-M group as compared with PCIA group. （2） There was no significant difference in the incidence of nausea and vomiting between the two groups. （3） The plasma morphine concentration versus time curve for RBC-M solution was fitted to two compartment model. The RBC-M solution had a longer T1/2, larger AUC0-∞ and lower CL. （4） The total morphinegroup. Conclusion Erythrocytes used as morphineeffective.consumption was higher in PCIA group than in RBC-M carrier for postoperative analgesia after CABG is safe and effective.
出处
《中华麻醉学杂志》
CAS
CSCD
北大核心
2005年第6期410-413,共4页
Chinese Journal of Anesthesiology
基金
江苏省发展基金资助项目(200012)
关键词
冠脉搭桥术
红细胞包蔽吗啡溶液
术后镇痛
可行性
Erythrocytes
Drug carries
Morphine
Coronary artery bypass
Analgesia
Pain,postoperative
