硫酸吗啡口服液在腹腔镜胆囊手术患者术后镇痛中的效果观察_West China Medical Journal

Authors：

周庆勇 ,  阴旭明

南江县人民医院麻醉科（四川南江 636600）;

Corresponding author：

阴旭明, Email: 383609835@qq.com

Keywords：

硫酸吗啡口服液; 腹腔镜胆囊切除术; 曲马多

DOI：

10.7507/1002-0179.201509088

Video：

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目的观察术前单次服用硫酸吗啡口服液联合术后曲马多自控镇痛在腹腔镜胆囊切除术后的镇痛效果。方法 2013 年 11 月—2014 年 3 月选择美国麻醉医师协会分级为Ⅰ～Ⅲ级，年龄 18～67 岁，择期行腹腔镜胆囊切除术患者 54 例，随机分为试验组（硫酸吗啡口服液组）和对照组（安慰剂组），各27例。采用疼痛视觉模拟（Visual Analogue Scale，VAS）评分评价两组患者术后清醒（T₁）及术后 4 h（T₂）、8 h（T₃）、12 h（T₄）与 24 h（T₅）疼痛程度（分别评估静息痛与运动痛），并对各时间点自控镇痛按压次数、曲马多总给药量及不良反应发生率进行对比。结果两组患者术后各时间点 VAS 评分均< 4 分，试验组术后 T₁、T₂ 运动痛 VAS 评分显著小于对照组（P<0.05），但静息痛及其余时间点运动痛 VAS 评分组间比较均无统计学意义（P>0.05）；试验组的自控镇痛按压次数和曲马多给药总量均少于对照组（P<0.05）；两组患者出现恶心、呕吐、呼吸抑制、尿潴留不良反应的发生率比较均无统计学意义（P>0.05）。结论术前单次给予 30 mg 硫酸吗啡口服液联合术后给予曲马多自控镇痛可以减轻腹腔镜胆囊切除术患者术后短期内的运动痛，同时可减少曲马多的使用量，但并不会降低其不良反应的发生率。

Citation： 周庆勇, 阴旭明. 硫酸吗啡口服液在腹腔镜胆囊手术患者术后镇痛中的效果观察. West China Medical Journal, 2017, 32(6): 886-888. doi: 10.7507/1002-0179.201509088 Copy

1.	李轶聪, 刘芳, 咸琳琳. 舒芬太尼用于腹腔镜胆囊切除术术后单次镇痛效果的评估. 实用预防医学, 2010, 17(5): 955-958.
2.	席文娟, 郭平选, 么安亮, 等. 地佐辛复合舒芬太尼与单用舒芬太尼对腹腔镜胆囊切除术后镇痛效果的比较. 河北医药, 2014(11): 1660-1661.
3.	Arkinstall WW, Goughnour BR, White JA, et al. Control of severe pain with sustained-release morphine tablets v. oral morphine solution. CMAJ, 1989, 140(6): 653-657, 661.
4.	Homsi J, Walsh D, Lasheen W, et al. A comparative study of 2 sustained-release morphine preparations for pain in advanced cancer. Am J Hosp Palliat Care, 2010, 27(2): 99-105.
5.	Maharjan SK, Shrestha S. Intraperitoneal and periportal injection of bupivacaine for pain after laparoscopic cholecystectomy. Kathmandu Univ Med J (KUMJ), 2009, 7(25): 50-53.
6.	Thomas S, Beevi S. Epidural dexamethasone reduces postoperative pain and analgesic requirements. Can J Anaesth, 2006, 53(9): 899-905.
7.	马晨光, 吴秀英. 氟比洛芬酯联合曲马多用于腹腔镜胆囊切除术术后镇痛. 实用药物与临床, 2009, 12(5): 324-326.
8.	Balch RJ, Trescot A. Extended-release morphine sulfate in treatment of severe acute and chronic pain. J Pain Res, 2010, 21(3): 191-200.
9.	Tuttle CB. Drug management of pain in cancer patients. Can Med Assoc J, 1985, 132(8): 899-900.
10.	Budd K. Chronic pain — challenge and response. Drugs, 1994, 47(1): 33-38.
11.	Petrella RJ, Disilvestro MD, Hildebrand C. Effects of hyaluronate Sodium on pain and physical functioning in osteoarthritis of the knee: a randomized, double-blind, placebo-controlled clinical trial. Arch Intern Med, 2002, 162(3): 292-298.
12.	Kelly S, Dunham JP, Murray F, et al. Spontaneous firing in C-fibers and increased mechanical sensitivity in A-fibers of knee joint-associated mechanoreceptive primary afferent neurones during MIA-induced osteoarthritis in the rat. Osteoarthritis Cartilage, 2012, 20(4): 305-313.
13.	Yaksh TL. Pharmacology and mechanisms of opioid analgesic activity. Acta Anaesthesiol Scand, 1997, 41(1 Pt 2): 94-111.
14.	Fanelli A, Ghisi D, Pergolotti B, et al. Pilot double-blinded study to assess efficacy and tolerability of morphine sulphate oral solution (Oramorph®) given preoperatively as add-on therapy within a multimodal postoperative pain approach in patients undergoing laparoscopic cholecystectomy. Minerva Anestesiol, 2014, 80(1): 66-75.
15.	Silvasti M, Svartling N, Pitkänen M, et al. Comparison of intravenous patient-controlled analgesia with tramadol versus morphine after microvascular breast Reconstruction. Eur J Anaesthesiol, 2000, 17(7): 448-455.

1. 李轶聪, 刘芳, 咸琳琳. 舒芬太尼用于腹腔镜胆囊切除术术后单次镇痛效果的评估. 实用预防医学, 2010, 17(5): 955-958.
2. 席文娟, 郭平选, 么安亮, 等. 地佐辛复合舒芬太尼与单用舒芬太尼对腹腔镜胆囊切除术后镇痛效果的比较. 河北医药, 2014(11): 1660-1661.
3. Arkinstall WW, Goughnour BR, White JA, et al. Control of severe pain with sustained-release morphine tablets v. oral morphine solution. CMAJ, 1989, 140(6): 653-657, 661.
4. Homsi J, Walsh D, Lasheen W, et al. A comparative study of 2 sustained-release morphine preparations for pain in advanced cancer. Am J Hosp Palliat Care, 2010, 27(2): 99-105.
5. Maharjan SK, Shrestha S. Intraperitoneal and periportal injection of bupivacaine for pain after laparoscopic cholecystectomy. Kathmandu Univ Med J (KUMJ), 2009, 7(25): 50-53.
6. Thomas S, Beevi S. Epidural dexamethasone reduces postoperative pain and analgesic requirements. Can J Anaesth, 2006, 53(9): 899-905.
7. 马晨光, 吴秀英. 氟比洛芬酯联合曲马多用于腹腔镜胆囊切除术术后镇痛. 实用药物与临床, 2009, 12(5): 324-326.
8. Balch RJ, Trescot A. Extended-release morphine sulfate in treatment of severe acute and chronic pain. J Pain Res, 2010, 21(3): 191-200.
9. Tuttle CB. Drug management of pain in cancer patients. Can Med Assoc J, 1985, 132(8): 899-900.
10. Budd K. Chronic pain — challenge and response. Drugs, 1994, 47(1): 33-38.
11. Petrella RJ, Disilvestro MD, Hildebrand C. Effects of hyaluronate Sodium on pain and physical functioning in osteoarthritis of the knee: a randomized, double-blind, placebo-controlled clinical trial. Arch Intern Med, 2002, 162(3): 292-298.
12. Kelly S, Dunham JP, Murray F, et al. Spontaneous firing in C-fibers and increased mechanical sensitivity in A-fibers of knee joint-associated mechanoreceptive primary afferent neurones during MIA-induced osteoarthritis in the rat. Osteoarthritis Cartilage, 2012, 20(4): 305-313.
13. Yaksh TL. Pharmacology and mechanisms of opioid analgesic activity. Acta Anaesthesiol Scand, 1997, 41(1 Pt 2): 94-111.
14. Fanelli A, Ghisi D, Pergolotti B, et al. Pilot double-blinded study to assess efficacy and tolerability of morphine sulphate oral solution (Oramorph®) given preoperatively as add-on therapy within a multimodal postoperative pain approach in patients undergoing laparoscopic cholecystectomy. Minerva Anestesiol, 2014, 80(1): 66-75.
15. Silvasti M, Svartling N, Pitkänen M, et al. Comparison of intravenous patient-controlled analgesia with tramadol versus morphine after microvascular breast Reconstruction. Eur J Anaesthesiol, 2000, 17(7): 448-455.

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West China Medical Journal

硫酸吗啡口服液在腹腔镜胆囊手术患者术后镇痛中的效果观察

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