Shroff A, Rooke G A, Bishop M J
Department of Anesthesiology, University of Washington, Seattle, USA.
J Clin Anesth. 1997 Aug;9(5):415-9. doi: 10.1016/s0952-8180(97)00081-0.
To determine if intrathecal opioid decreases time to extubation after coronary artery bypass surgery without compromising postoperative analgesia.
Prospective randomized trial.
Veterans Affairs Hospital.
21 ASA physical status III and IV men scheduled for elective coronary bypass surgery, who had not received medications that would impair anticoagulation at the time of surgery.
Patients were randomized to receive 10 micrograms/kg morphine and 25 micrograms fentanyl intrathecally preoperatively (n = 12) or no intrathecal opioid (n = 9). The latter group received 25 to 50 micrograms/kg fentanyl and 0.05 to 0.1 mg/kg midaxolam intraoperatively, whereas the intrathecal opioid group received intravenous (i.v.) fentanyl and midazolam only as needed. Both groups were administered i.v. morphine and midazolam postoperatively as needed by intensive care unit (ICU) personnel who were blinded to the treatment group.
For the first 24 hours postoperatively, pain levels (0 = none, to 10 = most severe) and sedation levels (1 = none, to 5 = unconscious) were measured hourly. The time to extubation and discharge from the ICU was recorded. ECG evidence of myocardial ischemia was noted. Pain scores were low for both groups (1.5), but the intrathecal opioid subjects exhibited less sedation than the high-dose fentanyl subjects [means +/- standard deviation (SD) of 2.3 +/- 0.4 vs. 2.8 +/- 0.5, p = 0.03]. Extubation time was 12 hours shorter in the intrathecal opioid group (2.9 +/- 5.3 vs. 14.7 +/- 6.8, p = 0.001). The five subjects with a one day ICU stay were all in the intrathecal opioid group (p = 0.04). The incidence of myocardial ischemia did not differ between the two groups.
Intrathecal opioid can facilitate early extubation and discharge from the ICU without compromising analgesia or increasing myocardial ischemia.
确定鞘内注射阿片类药物能否缩短冠状动脉搭桥手术后的拔管时间，同时不影响术后镇痛效果。
前瞻性随机试验。
退伍军人事务医院。
21例美国麻醉医师协会（ASA）身体状况为III级和IV级的男性，计划进行择期冠状动脉搭桥手术，手术时未接受会影响抗凝的药物治疗。
患者被随机分为两组，术前一组鞘内注射10微克/千克吗啡和25微克芬太尼（n = 12），另一组不进行鞘内注射阿片类药物（n = 9）。后一组术中接受25至50微克/千克芬太尼和0.05至0.1毫克/千克咪达唑仑，而鞘内注射阿片类药物组仅根据需要静脉注射芬太尼和咪达唑仑。两组术后均根据需要由对治疗组不知情的重症监护病房（ICU）人员静脉注射吗啡和咪达唑仑。
术后头24小时内，每小时测量疼痛程度（0 = 无疼痛，至10 = 最严重疼痛）和镇静程度（1 = 无镇静，至5 = 无意识）。记录拔管时间和从ICU出院的时间。记录心肌缺血的心电图证据。两组的疼痛评分均较低（1.5），但鞘内注射阿片类药物组的镇静程度低于高剂量芬太尼组[均值±标准差（SD）分别为2.3±0.4和2.8±0.5，p = 0.03]。鞘内注射阿片类药物组的拔管时间缩短12小时（2.9±5.3与14.7±6.8，p =0.001）。5例在ICU停留1天的患者均在鞘内注射阿片类药物组（p = 0.04）。两组之间心肌缺血的发生率无差异。
鞘内注射阿片类药物可促进早期拔管和从ICU出院，且不影响镇痛效果或增加心肌缺血发生率。
