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[硬膜外麻醉、氟烷麻醉或神经安定镇痛麻醉对镇痛药(丁丙诺啡、喷他佐辛、哌替啶)呼吸及血流动力学作用的影响(作者译)]

[Modification of the analgetic effects (buprenorphine, pentazocine, pethidine) on respiration and haemodynamics by epidural, halothane- or neuroleptanaesthesia (author's transl)].

作者信息

Wüst H J, Moritz K G, Sandmann W, Richter O

出版信息

Anasth Intensivther Notfallmed. 1980 Apr;15(2):119-34.

PMID:7396100
Abstract

In 38 patients buprenorphine, meperidine and pentazocine were given in a single dose for postoperative pain relief 20 hours after the end of anaesthesia. Measuring the parameters of the high- and low-pressure system as well as the metabolism the authors found that the effects of these analgetic medicaments, intravenously injected were significantly influenced by fentanyl, halothane or diazepam, given under the course of operation. Especially buprenorphine, injected after epidural anaesthesia in combination with diazepam sedation, proved to have a rather negative effect, because it caused a strong depression of respiration and circulation. On the other hand buprenorphine had, given after neuroleptanaesthesia, a neutralizing - and pentazocine and pethidine in combination with neuroleptanaesthesia a stimulating influence on the circulation. After halothane-anaesthesia the effect of the analegtics on the cardiovascular system was, when buprenorphine was given, depressing and when pentazocine was given indifferent. Similar reactions, but more pronounced, could be seen in the epidural group. With certain reservations, caused by the preliminary character of this study, the following conclusions can be drawn for the anaesthetic practice: 1 Choosing analgetic drugs for postoperative pain relief, the anaesthesist has to be aware of the interactions, possibly resulting from the medicaments, given during anaesthesia. 2. The number of medicaments, given during anaesthesia, should be kept small, considering the eventual interactions and the unintentional secondary effects.

摘要

对38例患者在麻醉结束20小时后给予丁丙诺啡、哌替啶和喷他佐辛单剂量以缓解术后疼痛。通过测量高低压系统参数以及代谢情况,作者发现,手术过程中给予的芬太尼、氟烷或地西泮会显著影响这些静脉注射镇痛药的效果。尤其是丁丙诺啡,在硬膜外麻醉联合地西泮镇静后注射,被证明有相当负面的影响,因为它会导致呼吸和循环的强烈抑制。另一方面,丁丙诺啡在神经安定麻醉后使用有中和作用,喷他佐辛和哌替啶在与神经安定麻醉联合使用时对循环有刺激作用。在氟烷麻醉后,给予丁丙诺啡时镇痛药对心血管系统有抑制作用,给予喷他佐辛时则无明显影响。在硬膜外组可观察到类似反应,但更为明显。由于本研究的初步性质,在麻醉实践中可以得出以下有一定保留的结论:1. 选择用于术后疼痛缓解的镇痛药时,麻醉医生必须意识到麻醉期间使用的药物可能产生的相互作用。2. 考虑到最终的相互作用和无意的副作用,麻醉期间使用的药物数量应保持在最少。

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