Davies Paul W, Vallejo Manuel C, Shannon Kelly T, Amortegui Antonio J, Ramanathan Sivam
University of Pittsburgh School of Medicine, Department of Anesthesiology, Magee-Womens Hospital, Pittsburgh, Pennsylvania.
Anesth Analg. 2005 May;100(5):1472-1476. doi: 10.1213/01.ANE.0000153013.34129.A7.
There is now evidence for an association between the use of epidural morphine and reactivation of herpes simplex labialis (HSL). There are no studies that definitively demonstrate the relationship between HSL reactivation and spinal intrathecal morphine. To investigate this relationship, we randomized and prospectively studied 100 obstetric patients with a history of HSL undergoing cesarean delivery under spinal anesthesia. One group received intrathecal morphine plus IV morphine via patient-controlled analgesia (ITM+PCA group) for postoperative analgesia, and a second group received only IV morphine via patient-controlled analgesia for postoperative analgesia (PCA-only group). Patients were followed for a 30-day period. In the ITM+PCA group 19 (38%) patients had HSL reactivation whereas eight (16.6%) had HSL reactivation in the morphine PCA-only group (P = 0.028). The incidence of pruritus in the ITM+PCA group was also more frequent in the early postoperative period. Our data show HSL reactivation in both the ITM+PCA group and PCA-only morphine group, with a more frequent incidence in the ITM+PCA group.
目前有证据表明硬膜外使用吗啡与唇疱疹（HSL）复发之间存在关联。尚无研究能确切证明HSL复发与脊髓鞘内注射吗啡之间的关系。为了探究这种关系，我们对100例有HSL病史且在脊髓麻醉下接受剖宫产的产科患者进行了随机前瞻性研究。一组通过患者自控镇痛接受鞘内吗啡加静脉注射吗啡用于术后镇痛（鞘内吗啡+患者自控镇痛组），另一组仅通过患者自控镇痛接受静脉注射吗啡用于术后镇痛（仅患者自控镇痛组）。对患者进行了30天的随访。在鞘内吗啡+患者自控镇痛组中，19例（38%）患者出现HSL复发，而在仅吗啡患者自控镇痛组中有8例（16.6%）出现HSL复发（P = 0.028）。鞘内吗啡+患者自控镇痛组在术后早期瘙痒的发生率也更高。我们的数据显示，鞘内吗啡+患者自控镇痛组和仅吗啡患者自控镇痛组均出现了HSL复发，鞘内吗啡+患者自控镇痛组的发生率更高。
