Götz E, Bogosyan S, Müller E, Litz R
Institut für Anästhesiologie und Operative Intensivmedizin, Städtische Kliniken Darnstadt.
Anasthesiol Intensivmed Notfallmed Schmerzther. 1995 Feb;30(1):28-31. doi: 10.1055/s-2007-996442.
Postoperative shivering is common and has potentially adverse side effects in high-risk patients. Meperidine, which binds to both mu- and kappa-opioid receptors, is reported to be more effective in treating shivering than morphine or fentanyl. Recent data indicate that much of meperidine's special antishivering effect may be mediated by its kappa-opioid receptor activity. Nalbuphine, an opioid agonist/antagonist also has a potent affinity for kappa-receptors. The aim of this study was to evaluate the antishivering effect of nalbuphine in comparison to meperidine.
100 ASA physical status I-II patients shivering after elective surgery were included in the study. General anaesthesia was performed with thiopentone, low-dose fentanyl and enflurane in N2O/O2. After arrival in the recovery room patients shivering within 5 min received either meperidine 25 mg or nalbupine 10 mg in a double-blind, randomised manner. The duration and severity of shivering, heart rate, respiratory rate, blood pressure, end-tidal CO2 concentration, O2-saturation and awareness were documented until 20 min after injection. Patients in need of a second injection were excluded from the study.
Demographic variables, duration of operation and temperature decreases were not significantly different between treatment groups. The suppression of shivering was achieved within 4.0 +/- 3.5 or 4.6 +/- 4.1 min following the injection of meperidine or nalbuphine, respectively (p = NS). Vital signs and postoperative vigilance showed no significant differences. No adverse side effects were observed.
The data indicated that nalbuphine suppressed postoperative shivering as effectively and timely as meperidine in equianalgesic doses. The observation is consistent with the hypothesis that stimulation of kappa-opioid receptors is a likely explanation for much of meperidine's antishivering action.
术后寒战很常见，且在高危患者中可能产生不良副作用。据报道，与μ-阿片受体和κ-阿片受体均有结合的哌替啶在治疗寒战方面比吗啡或芬太尼更有效。近期数据表明，哌替啶的特殊抗寒战作用很大程度上可能由其κ-阿片受体活性介导。纳布啡，一种阿片受体激动剂/拮抗剂，对κ-受体也有很强的亲和力。本研究的目的是评估纳布啡与哌替啶相比的抗寒战效果。
100例择期手术后寒战的美国麻醉医师协会（ASA）身体状况I-II级患者纳入本研究。采用硫喷妥钠、低剂量芬太尼和恩氟烷在N2O/O2中进行全身麻醉。到达恢复室后，5分钟内出现寒战的患者以双盲、随机方式接受25毫克哌替啶或10毫克纳布啡。记录注射后20分钟内寒战的持续时间和严重程度、心率、呼吸频率、血压、呼气末二氧化碳浓度、氧饱和度和意识。需要第二次注射的患者被排除在研究之外。
治疗组之间的人口统计学变量、手术持续时间和体温下降无显著差异。分别在注射哌替啶或纳布啡后4.0±3.5分钟或4.6±4.1分钟内实现了寒战抑制（p=无显著性差异）。生命体征和术后警觉性无显著差异。未观察到不良副作用。
数据表明，在等效镇痛剂量下，纳布啡抑制术后寒战的效果与哌替啶一样有效且及时。该观察结果与以下假设一致，即κ-阿片受体的刺激很可能是哌替啶大部分抗寒战作用的解释。
