静脉与硬膜外注射地塞米松对吗啡硬膜外术后镇痛的影响

目的:比较两种不同途径注射地塞米松磷酸钠对吗啡硬膜外术后镇痛的影响。方法:选择200例(ASAⅠ-Ⅱ)在腰硬联合麻醉下行腹式子宫切除术的患者,随机分为A、B、C、D四组(n=50),各组均给以硬膜外注射2.5 mg吗啡作为术后镇痛治疗的同时,A组静脉注射安慰剂(生理盐水),B组静脉注射地塞米松磷酸钠10 mg,C组静脉注射地塞米松磷酸钠5 mg,D组硬膜外注射地塞米松磷酸钠5 mg及静脉注射安慰剂(生理盐水),以上均以5 mL作为注射容积。观察和比较术后24 h内各组恶心和呕吐(PONV)、皮肤瘙痒、补救镇痛、呼吸抑制的发生率、排气时间和补救镇痛时间。结果:B、C、D三组的PONV总发生率显著低于A组(P0.0083),而B、C、D三组之间比较无显著差异(P0.0083);A、B、C、D四组间恶心的发生率无显著差异(P0.05),而D组呕吐的发生率明显低于A组(P0.0083);B组皮肤瘙痒的发生率明显低于A组(P0.0083);四组患者的VAS评分比较无显著差异,均达到满意的镇痛效果(P0.05)。四组患者补救镇痛的发生率、补救镇痛药量和排气时间比较无明显差异(P0.05),而C、D组的补救镇痛时间明显比A组延长(P0.0083),四组患者均未出现呼吸抑制。结论:地塞米松磷酸钠可降低吗啡硬膜外术后恶心和呕吐的发生率,延长补救镇痛时间;硬膜外注射地塞米松磷酸钠对降低呕吐的发生率更有效;静脉注射地塞米松磷酸钠10 mg可降低瘙痒的发生率,且无明显的不良反应。

The Effect of Dexamethasone on Postoperative Epidural Analgesia of Morphine: a Comparasion Study of Intravenous and Epidural Injection Routes

Objective： A prospective, randomized, double-blinded and placebo-controlled study was designed to compare the effe- cts of dexamethasone sodium phosphate administration Intravenously or epiduraUy on the postoperative epidural analgesia of morphine. Methods： A total of 200 patients（ASA I - II） who had scheduled for elective simple abdominal hysterectomy under combined spinal-epi- dural anesthesia were randomly divided into four groups, A, B, C and D （n = 50）. Aider peritoneal suture, each patient received epidural morphine 2.5 mg as postoperative analgesia. At the same time, each patient in group A received I.V. saline as placebo; each patient in group B received I.V. dexamethasone sodium phosphate 10 mg; each patient in group C received I.V. dexamethasone sodium phosphate 5 rag; each patient in group D received epidural dexamethasone sodium phosphate 5 mg and I.V. saline, the incidence of pruritus, nausea and vomiting （PONV）, remedy analgesia and respiratory depression, the exhaust time and the remedy analgesia time were recorded and compared among different groups. Results： The incidence rates of PONV in group B, C and D were significantly lower （P〈0.0083） than group A, but no significant difference was found among group B, C and D; no significant difference of the incidence rates of nausea was found among four groups, the incidence rate of vomiting in group D was significantly lower than that of group A （P〈0.0083）. The incide- nce rate of pruritus in group B was significantly lower than that of group A （P〈0.0083）; the time course before without remedial analgesic in group C and D were significant longer than that in group A （P〈0.0083） and no respiration inhibition was observed in the four groups. Conclusion： Combined with morphine as postoperative epidural analgesia, Dexamethasone could reduce the incidence rate of PONV and vomiting; prolong the time course without remedial analgesic regardless of intravenous or epidural injection. Epidural dexamethasone sodium phosphate significantly reduced the incidence of vomiting more effectively than I.V. dexamethasone.I.V; Dexamethasone sodium phosphate 10 mg significantly reduced the incidence of pruritus without significant side effect.