摘要
目的 观察芬太尼和吗啡通过不同途径用于术后病人自控镇痛(PCA)的药效学和PCA期间的血药浓度。方法随机选择ASA Ⅰ～Ⅱ级择期手术病例60例,分为Ⅰ组(硬膜外0.13％布比卡因+芬太尼2μg/m1),Ⅱ组(硬膜外0.13％布比卡因+吗啡O.08mg/ml),Ⅲ组(静脉吗啡0.5mg/ml),每组各20例。Ⅰ组及Ⅱ组维持剂量4 ml/h,PCA剂量为2 ml,锁定时间为20 min;Ⅲ组维持剂量1 ml/h,PCA剂量为2 ml,锁定时间为6min,均镇痛48 h。观察PCA后4 h、24 h、48 h患者的生命体征,镇痛效果以及各种副反应,并由肘静脉抽血以放免的方法测定芬太尼和吗啡的血药浓度。结果 Ⅱ组及Ⅲ组副反应的发生率高。Ⅱ组48 h进药容量要明显少于Ⅰ组(P<0.05)。Ⅰ组芬太尼的血药浓度低于文献报道的最小有效镇痛浓度(MEC),Ⅱ组吗啡4 h的血药浓度低于MEC,而24 h和48 h的血药浓度则要高于MEC。三组病人PCA后4 h、24 h、48 h的生命体征以及镇痛效果差异均无显著性(P>0.05)。结论芬太尼和吗啡经PCA用于临床术后镇痛的效果满意,而且安全,宜根据病人的情况以及手术的需要决定采取术后镇痛方式。
Objective To determine the plasma concentrations and pharmacodynamics of fentanyl and nerphine used in postoperative epidural or intravenous patient-controlled analgesia (PCEA,PCIA) .Methods Sixty ASA Ⅰ - Ⅱ patients (36 male, 24 female), aged 18-25 yr undergoing elective major operation were randomly divided into 3 groups : group Ⅰ received PCEA with 0.13 % bupivacaine + fentanyl 2μg·ml-1 (n = 20) ; groupⅡ received PCEA with 0.13 % bupivacaine + morphine 0.08 mg· ml-1 ( n = 20); group Ⅲ received PCIA with morphine 0.5 mg · ml-1 ( n = 20). In group Ⅰ and Ⅱ the background infusion rate was 4 ml · h-1 , PCA bolus dose 2 ml and lock-out interval 20 min, while in group Ⅲ the back ground infusion rate was 1 ml·h-1 , PCA bolus dose 2 ml and lock-out interval 6 min. PCA was maintained for 48 h in all three groups. The vital signs, analgesic effect (VAS, VRS) and side-effects were recorded and venous blood samples were taken for determination of plasma fentanyl and morphine concentrations at 4 h, 24 h and 48 h after PCA was commenced. Results The demographic data were comparable among the three groups. There was no significant difference in MAP, HR and RR during PCA among the three groups. The analgesia was satisfactory in all three groups and no other analgesic was used during PCA. The rate of excellent analgesia ranged between 80%-85 % . The incidences of side-effects were higher in group Ⅱ and Ⅲ as compared with those in group Ⅰ . The volume of epidural PCA solution administered in 48 h was significantly larger in group Ⅰ than that in group Ⅱ( P < 0.05) . The plasma fentanyl concentration was lower than minimal effective concentration (MEC) in group Ⅰ , while the plasma morphine concentration was lower than MEC at 4 h and higher than MEC at 24 and 48 h in group Ⅱ . Conclusion PCA with fentanyl and morphine is satisfactory and safe. The PCA modalities used depend on the individual patient and surgery.
出处
《中华麻醉学杂志》
CAS
CSCD
北大核心
2003年第6期419-422,共4页
Chinese Journal of Anesthesiology
