Dailey P A, Brookshire G L, Shnider S M, Abboud T K, Kotelko D M, Noueihid R, Thigpen J W, Khoo S S, Raya J A, Foutz S E
Anesth Analg. 1985 Jul;64(7):658-66.
The efficacy of naloxone in reducing the incidence of side effects after intrathecal injection of morphine and the effects of maternal naloxone administration on the condition of the newborn were evaluated in 40 patients. Patients in labor were given a 1-mg intrathecal injection of morphine and, 1 hr later, either a 0.4-mg bolus of naloxone, followed by a 0.4-0.6 mg/hr intravenous infusion of naloxone, or an intravenous bolus of saline, followed by an intravenous infusion of saline. Intrathecal morphine provided at least 50% pain relief in 78% of patients given naloxone, and in 82% given saline. Intravenous naloxone significantly decreased the incidence of pruritus during labor and delivery. There was no significant decrease in the incidence of nausea, vomiting, somnolence, dizziness, or urinary retention in patients given naloxone. Despite placental transfer of naloxone, neonatal outcome was not adversely affected. For both groups, maternal beta-endorphin levels decreased significantly with the onset of analgesia and returned to control levels at delivery. We conclude that intravenous infusion of naloxone reduced pruritus after intrathecal injection of 1 mg of morphine for labor pain without lessening analgesia or adversely affecting maternal or neonatal status.
在40例患者中评估了纳洛酮在降低鞘内注射吗啡后副作用发生率方面的疗效以及母体给予纳洛酮对新生儿状况的影响。临产患者鞘内注射1毫克吗啡，1小时后，一组给予0.4毫克纳洛酮推注，随后以0.4 - 0.6毫克/小时的速度静脉输注纳洛酮，另一组给予静脉推注生理盐水，随后静脉输注生理盐水。鞘内注射吗啡后，78%接受纳洛酮治疗的患者和82%接受生理盐水治疗的患者疼痛缓解至少50%。静脉注射纳洛酮显著降低了分娩期间瘙痒的发生率。接受纳洛酮治疗的患者恶心、呕吐、嗜睡、头晕或尿潴留的发生率没有显著降低。尽管纳洛酮可通过胎盘转运，但对新生儿结局没有不利影响。两组患者的母体β-内啡肽水平在镇痛开始时均显著下降，并在分娩时恢复到对照水平。我们得出结论，静脉输注纳洛酮可降低鞘内注射1毫克吗啡用于分娩镇痛后的瘙痒发生率，且不会减弱镇痛效果或对母体或新生儿状况产生不利影响。
