肋间胸廓切开术后犬的肺功能及镇痛评估,以及肌肉注射或胸膜内注射吗啡和胸膜内注射布比卡因的应用。
Evaluation of pulmonary function and analgesia in dogs after intercostal thoracotomy and use of morphine administered intramuscularly or intrapleurally and bupivacaine administered intrapleurally.
作者信息
Stobie D, Caywood D D, Rozanski E A, Bing D R, Dhokarikar P, Raffe M R, Kannan M S, King V L, Hegstad R L, Randall D A
机构信息
Department of Small Animal Clinical Sciences, College of Veterinary Medicine, University of Minnesota, St Paul 55108, USA.
出版信息
Am J Vet Res. 1995 Aug;56(8):1098-109.
Eighteen dogs undergoing lateral thoracotomy at the left fifth intercostal space were randomly assigned to 1 of 3 postoperative analgesic treatment groups of 6 dogs each as follows: group A, morphine, 1.0 mg/kg of body weight, IM; group B, 0.5% bupivacaine, 1.5 mg/kg given interpleurally; and group C, morphine, 1.0 mg/kg given interpleurally. Heart rate, respiratory rate, arterial blood pressure, arterial blood gas tensions, alveolar-arterial oxygen differences, rectal temperature, pain score, and pulmonary mechanics were recorded hourly for the first 8 hours after surgery, and at postoperative hours 12, 24, and 48. These values were compared with preoperative (control) values for each dog. Serum morphine and cortisol concentrations were measured at 10, 20, and 30 minutes, hours 1 to 8, and 12 hours after treatment administration. All dogs had significant decreases in pHa, PaO2, and oxygen saturation of hemoglobin, and significant increases in PaCO2 and alveolar-arterial oxygen differences in the postoperative period, but these changes were less severe in group-B dogs. Decreases of 50% in lung compliance, and increases of 100 to 200% in work of breathing and of 185 to 383% in pulmonary resistance were observed in all dogs after surgery. Increases in work of breathing were lower, and returned to preoperative values earlier in group-B dogs. The inspiratory time-to-total respiratory time ratio was significantly higher in group-B dogs during postoperative hours 5 to 8, suggesting improved analgesia. Blood pressure was significantly lower in group-A dogs for the postoperative hour. Significant decreases in rectal temperature were observed in all dogs after surgery, and hypothermia was prolonged in dogs of groups A and C. Significant differences in pain score were not observed between treatment groups. Cortisol concentration was high in all dogs after anesthesia and surgery, and was significantly increased in group-B dogs at hours 4 and 8. Significant differences in serum morphine concentration between groups A and C were only observed 10 minutes after treatment administration. In general, significant differences in physiologic variables between groups A and C were not observed. Results of the study indicate that the anesthesia and thoracotomy are associated with significant alterations in pulmonary function and lung mechanics. Interpleurally administered bupivacaine appears to be associated with fewer blood gas alterations and earlier return to normal of certain pulmonary function values. Interpleural administration of morphine does not appear to provide any advantages, in terms of analgesia or pulmonary function, compared with its IM administration.
18只在左第五肋间进行侧胸切开术的犬被随机分为3个术后镇痛治疗组,每组6只,分组如下:A组,吗啡,1.0mg/kg体重,肌肉注射;B组,0.5%布比卡因,1.5mg/kg经胸膜内给药;C组,吗啡,1.0mg/kg经胸膜内给药。术后前8小时每小时记录心率、呼吸频率、动脉血压、动脉血气张力、肺泡-动脉氧分压差、直肠温度、疼痛评分和肺力学指标,术后12、24和48小时也进行记录。将这些值与每只犬的术前(对照)值进行比较。在给药后10、20和30分钟、1至8小时以及12小时测量血清吗啡和皮质醇浓度。所有犬在术后期间动脉血pH值、动脉血氧分压和血红蛋白氧饱和度均显著降低,动脉血二氧化碳分压和肺泡-动脉氧分压差显著升高,但B组犬的这些变化较轻。术后所有犬的肺顺应性降低50%,呼吸功增加100%至200%,肺阻力增加185%至383%。B组犬呼吸功的增加较低,且恢复到术前值的时间较早。术后5至8小时,B组犬吸气时间与总呼吸时间的比值显著更高,提示镇痛效果改善。术后1小时A组犬血压显著降低。术后所有犬直肠温度均显著降低,A组和C组犬体温过低持续时间延长。各治疗组之间疼痛评分无显著差异。麻醉和手术后所有犬的皮质醇浓度均较高,B组犬在4小时和8小时时皮质醇浓度显著升高。仅在给药后10分钟观察到A组和C组之间血清吗啡浓度存在显著差异。总体而言,未观察到A组和C组之间生理变量存在显著差异。研究结果表明,麻醉和胸切开术与肺功能和肺力学的显著改变有关。经胸膜内给药的布比卡因似乎与较少的血气改变以及某些肺功能值较早恢复正常有关。与肌肉注射相比,经胸膜内注射吗啡在镇痛或肺功能方面似乎没有任何优势。