Martín-Larrauri R, Mestre C, Bárcena A, Cañizal J M, de la Torre J
Servicio de Anestesiología y Reanimación, Hospital Universitario del Aire, Madrid.
Rev Esp Anestesiol Reanim. 1995 Feb;42(2):41-6.
A series of 45 adults were distributed into 3 groups of 15 patients each based on site of surgery and site of preanesthetic (30 min) injection of 0.5 mg pure morphine. Control group (C0) patients underwent lumbar surgery and received subcutaneous morphine. Group C0.5 patients also underwent lumbar surgery but received intrathecal morphine. Group A0.5 patients underwent long-duration high abdominal surgery and received intrathecal morphine. Anesthesia was maintained with nitrous oxide (60%) in oxygen (40%) and a variable concentration of isoflurane. Isoflurane needs were assessed by averaging six consecutive measurements of end-tidal isoflurane pressure (M30FETiso) taken at intervals of 5 min. Postoperative analgesia was evaluated by means of a visual analog scale that was converted to numerical units (VASn).
M30FETiso in group C0 (0.8%) was always higher (p < 0.01) than in the other two groups. M30FETiso in group A0.5 was higher (p < 0.01) than in group C0.5 during the first 150 min of surgery. After 180 min, there were no differences in M30FETiso (0.10-0.16%) between the two groups receiving intrathecal morphine. VASn results (mean +/- SD) in the first 4 hours were higher in group C0 (7.33 +/- 0.6) than in group C0.5 (1.13 +/- 0.35) and group A0.5 (1.07 +/- 0.26). The time of morphine-dependent analgesia was shorter (p < 0.01) in group C0 (0.62 +/- 0.38 hours) than in groups C0.5 (30.4 +/- 5.11 hours) and A0.5 (28 +/- 4.34 hours). There were no significant differences between the two groups receiving intrathecal morphine.
Preanesthetic subarachnoid lumbar injection of 0.5 mg of pure morphine reduced early requirements for isoflurane in lumbar surgery (0.14% after 60 min). This reduction was initially less in patients undergoing abdominal surgery (0.44% at 60 min) but was the same after 150 min. Postoperative analgesia was long-term and independent of type or duration of surgery. There was no respiratory depression after surgery and the incidence of postoperative complications was similar in the two groups that received subarachnoid morphine.
1）确定麻醉前鞘内注射0.5毫克吗啡是否能降低维持麻醉所需的异氟烷剂量。2）评估术后镇痛的持续时间以及该操作所致并发症的类型和发生率。
45名成年人根据手术部位和麻醉前（30分钟）0.5毫克纯吗啡的注射部位分为3组，每组15名患者。对照组（C0）患者接受腰椎手术并皮下注射吗啡。C0.5组患者也接受腰椎手术但鞘内注射吗啡。A0.5组患者接受长时间上腹部手术并鞘内注射吗啡。麻醉维持采用60%氧化亚氮与40%氧气混合，并使用可变浓度的异氟烷。通过平均连续6次间隔5分钟测量的呼气末异氟烷分压（M30FETiso）来评估异氟烷需求量。术后镇痛通过视觉模拟量表评估，该量表转换为数值单位（VASn）。
C0组（0.8%）的M30FETiso始终高于其他两组（p < 0.01）。在手术的前150分钟内，A0.5组的M30FETiso高于C0.5组（p < 0.01）。180分钟后，接受鞘内注射吗啡的两组之间M30FETiso（0.10 - 0.16%）无差异。前4小时VASn结果（均值±标准差）C0组（7.33 ± 0.6）高于C0.5组（1.13 ± 0.35）和A0.5组（1.07 ± 0.26）。C0组（0.62 ± 0.38小时）吗啡依赖镇痛时间短于C0.5组（30.4 ± 5.11小时）和A0.5组（28 ± 4.34小时）（p < 0.01）。接受鞘内注射吗啡的两组之间无显著差异。
麻醉前蛛网膜下腔腰椎注射0.5毫克纯吗啡可降低腰椎手术早期对异氟烷的需求量（60分钟后为0.14%）。这种降低在接受腹部手术的患者中最初较小（60分钟时为0.44%），但150分钟后相同。术后镇痛是长期的，且与手术类型或持续时间无关。术后无呼吸抑制，接受蛛网膜下腔吗啡注射的两组术后并发症发生率相似。
