Chen J C, Hsu S W, Hu L H, Hong Y J, Tsai P S, Lin T C, Lin C F, Wei T T
Department of Anesthesiology, Mackay Memorial Hospital, Taipei.
Ma Zui Xue Za Zhi. 1993 Mar;31(1):19-24.
Shivering is a common and complex phenomenon that occurs in many patients during spinal anesthesia. Shivering can increase oxygen consumption up to 500 per cent which may be detrimental to patients with decreased myocardial reserve. The metabolic costs and cardiorespiratory consequences of shivering are important particularly for patients with anemia, coronary arterial disease, cardiopulmonary insufficient, debilitated status or are elderly. We studied whether intrathecal meperidine could prevent shivering after spinal anesthesia. 60 patients with ASA class I-II were divided into intrathecal meperidine group (Group I) (n = 30) and control group (Group II) (n = 30). Group I received spinal tetracaine 12-16 mg with meperidine 0.2 mg/kg and Group II received spinal tetracaine 12-16 mg without meperidine. During operation the highest level of spinal anesthesia, ambient and rectal temperatures, blood pressure (BP) and heart rate (HR), presence or absence of shivering, intensity of shivering in both groups were recorded. Close observation for side effects was given post-operatively. There was a significant reduction (p < .005) in incidence of shivering in group I patients (16.7%) when compared with group II (56.7%). There was no or less side effects observed with other neuraxial opioids except nausea. We concluded that intrathecal meperidine could suppress shivering induced by spinal anesthesia.
寒战是一种常见且复杂的现象，在许多接受脊髓麻醉的患者中都会出现。寒战可使耗氧量增加达500%，这可能对心肌储备功能下降的患者不利。寒战的代谢成本和心肺后果很重要，特别是对于贫血、冠状动脉疾病、心肺功能不全、身体虚弱或老年患者。我们研究了鞘内注射哌替啶是否能预防脊髓麻醉后的寒战。60例ASA I-II级患者分为鞘内注射哌替啶组（I组）（n = 30）和对照组（II组）（n = 30）。I组接受12 - 16 mg丁卡因加0.2 mg/kg哌替啶鞘内注射，II组接受12 - 16 mg丁卡因但不添加哌替啶鞘内注射。手术期间记录两组的最高脊髓麻醉平面、环境温度和直肠温度、血压（BP）和心率（HR）、是否出现寒战以及寒战强度。术后密切观察副作用。与II组（56.7%）相比，I组患者的寒战发生率显著降低（p <.005）（16.7%）。除恶心外，未观察到其他神经轴索类阿片药物有副作用或副作用较少。我们得出结论，鞘内注射哌替啶可抑制脊髓麻醉诱导的寒战。
