Chaney M A, Smith K R, Barclay J C, Slogoff S
Department of Anesthesiology, Loyola University Medical Center, Maywood, Illinois 60153, USA.
Anesth Analg. 1996 Aug;83(2):215-22. doi: 10.1097/00000539-199608000-00003.
Aggressive control of pain during the immediate postoperative period after cardiac surgery, associated with decreased blood catecholamine levels, may decrease morbidity and mortality. This study investigated the use of large-dose intrathecal morphine for cardiac surgery and its effect on postoperative analgesic requirements and blood catecholamine levels. Patients were randomized to receive either 4.0 mg of intrathecal morphine (Group MS) or intrathecal saline placebo (Group NS). Perioperative care was standardized and included postoperative patient-controlled analgesia. Arterial blood samples were obtained perioperatively to ascertain catecholamine levels. Patients in Group MS required significantly less postoperative intravenous morphine than patients in Group NS. Although perioperative norepinephrine and epinephrine levels in Group MS patients tended to be lower than Group NS patients, the differences were not statistically significant. In conclusion, large-dose intrathecal morphine initiates reliable postoperative analgesia but does not reliably attenuate the stress response during and after cardiac surgery.
心脏手术后即刻积极控制疼痛，与血液中儿茶酚胺水平降低相关，可能会降低发病率和死亡率。本研究调查了大剂量鞘内注射吗啡在心脏手术中的应用及其对术后镇痛需求和血液儿茶酚胺水平的影响。患者被随机分为接受4.0毫克鞘内注射吗啡组（MS组）或鞘内注射生理盐水安慰剂组（NS组）。围手术期护理标准化，包括术后患者自控镇痛。围手术期采集动脉血样本以确定儿茶酚胺水平。MS组患者术后所需静脉注射吗啡量明显少于NS组患者。虽然MS组患者围手术期去甲肾上腺素和肾上腺素水平倾向于低于NS组患者，但差异无统计学意义。总之，大剂量鞘内注射吗啡可产生可靠的术后镇痛效果，但不能可靠地减轻心脏手术期间及术后的应激反应。
