硫酸嗎啡口服液在腹腔鏡膽囊手術患者術后鎮痛中的效果觀察_West China Medical Journal

Authors：

周慶勇 ,  陰旭明

南江縣人民醫院麻醉科（四川南江? 636600）;

Corresponding?author：

陰旭明, Email: 383609835@qq.com

Keywords：

硫酸嗎啡口服液; 腹腔鏡膽囊切除術; 曲馬多

DOI：

10.7507/1002-0179.201509088

Video：

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目的觀察術前單次服用硫酸嗎啡口服液聯合術后曲馬多自控鎮痛在腹腔鏡膽囊切除術后的鎮痛效果。方法 2013 年 11 月—2014 年 3 月選擇美國麻醉醫師協會分級為Ⅰ～Ⅲ級，年齡 18～67 歲，擇期行腹腔鏡膽囊切除術患者 54 例，隨機分為試驗組（硫酸嗎啡口服液組）和對照組（安慰劑組），各27例。采用疼痛視覺模擬（Visual Analogue Scale，VAS）評分評價兩組患者術后清醒（T₁）及術后 4 h（T₂）、8 h（T₃）、12 h（T₄）與 24 h（T₅）疼痛程度（分別評估靜息痛與運動痛），并對各時間點自控鎮痛按壓次數、曲馬多總給藥量及不良反應發生率進行對比。結果兩組患者術后各時間點 VAS 評分均< 4 分，試驗組術后 T₁、T₂ 運動痛 VAS 評分顯著小于對照組（P<0.05），但靜息痛及其余時間點運動痛 VAS 評分組間比較均無統計學意義（P>0.05）；試驗組的自控鎮痛按壓次數和曲馬多給藥總量均少于對照組（P<0.05）；兩組患者出現惡心、嘔吐、呼吸抑制、尿潴留不良反應的發生率比較均無統計學意義（P>0.05）。結論術前單次給予 30 mg 硫酸嗎啡口服液聯合術后給予曲馬多自控鎮痛可以減輕腹腔鏡膽囊切除術患者術后短期內的運動痛，同時可減少曲馬多的使用量，但并不會降低其不良反應的發生率。

Citation： 周慶勇, 陰旭明. 硫酸嗎啡口服液在腹腔鏡膽囊手術患者術后鎮痛中的效果觀察. West China Medical Journal, 2017, 32(6): 886-888. doi: 10.7507/1002-0179.201509088 Copy

1.	李軼聰, 劉芳, 咸琳琳. 舒芬太尼用于腹腔鏡膽囊切除術術后單次鎮痛效果的評估. 實用預防醫學, 2010, 17(5): 955-958.
2.	席文娟, 郭平選, 么安亮, 等. 地佐辛復合舒芬太尼與單用舒芬太尼對腹腔鏡膽囊切除術后鎮痛效果的比較. 河北醫藥, 2014(11): 1660-1661.
3.	Arkinstall WW, Goughnour BR, White JA, et al. Control of severe pain with sustained-release morphine tablets v. oral morphine solution. CMAJ, 1989, 140(6): 653-657, 661.
4.	Homsi J, Walsh D, Lasheen W, et al. A comparative study of 2 sustained-release morphine preparations for pain in advanced cancer. Am J Hosp Palliat Care, 2010, 27(2): 99-105.
5.	Maharjan SK, Shrestha S. Intraperitoneal and periportal injection of bupivacaine for pain after laparoscopic cholecystectomy. Kathmandu Univ Med J (KUMJ), 2009, 7(25): 50-53.
6.	Thomas S, Beevi S. Epidural dexamethasone reduces postoperative pain and analgesic requirements. Can J Anaesth, 2006, 53(9): 899-905.
7.	馬晨光, 吳秀英. 氟比洛芬酯聯合曲馬多用于腹腔鏡膽囊切除術術后鎮痛. 實用藥物與臨床, 2009, 12(5): 324-326.
8.	Balch RJ, Trescot A. Extended-release morphine sulfate in treatment of severe acute and chronic pain. J Pain Res, 2010, 21(3): 191-200.
9.	Tuttle CB. Drug management of pain in cancer patients. Can Med Assoc J, 1985, 132(8): 899-900.
10.	Budd K. Chronic pain — challenge and response. Drugs, 1994, 47(1): 33-38.
11.	Petrella RJ, Disilvestro MD, Hildebrand C. Effects of hyaluronate Sodium on pain and physical functioning in osteoarthritis of the knee: a randomized, double-blind, placebo-controlled clinical trial. Arch Intern Med, 2002, 162(3): 292-298.
12.	Kelly S, Dunham JP, Murray F, et al. Spontaneous firing in C-fibers and increased mechanical sensitivity in A-fibers of knee joint-associated mechanoreceptive primary afferent neurones during MIA-induced osteoarthritis in the rat. Osteoarthritis Cartilage, 2012, 20(4): 305-313.
13.	Yaksh TL. Pharmacology and mechanisms of opioid analgesic activity. Acta Anaesthesiol Scand, 1997, 41(1 Pt 2): 94-111.
14.	Fanelli A, Ghisi D, Pergolotti B, et al. Pilot double-blinded study to assess efficacy and tolerability of morphine sulphate oral solution (Oramorph?) given preoperatively as add-on therapy within a multimodal postoperative pain approach in patients undergoing laparoscopic cholecystectomy. Minerva Anestesiol, 2014, 80(1): 66-75.
15.	Silvasti M, Svartling N, Pitk?nen M, et al. Comparison of intravenous patient-controlled analgesia with tramadol versus morphine after microvascular breast Reconstruction. Eur J Anaesthesiol, 2000, 17(7): 448-455.

1. 李軼聰, 劉芳, 咸琳琳. 舒芬太尼用于腹腔鏡膽囊切除術術后單次鎮痛效果的評估. 實用預防醫學, 2010, 17(5): 955-958.
2. 席文娟, 郭平選, 么安亮, 等. 地佐辛復合舒芬太尼與單用舒芬太尼對腹腔鏡膽囊切除術后鎮痛效果的比較. 河北醫藥, 2014(11): 1660-1661.
3. Arkinstall WW, Goughnour BR, White JA, et al. Control of severe pain with sustained-release morphine tablets v. oral morphine solution. CMAJ, 1989, 140(6): 653-657, 661.
4. Homsi J, Walsh D, Lasheen W, et al. A comparative study of 2 sustained-release morphine preparations for pain in advanced cancer. Am J Hosp Palliat Care, 2010, 27(2): 99-105.
5. Maharjan SK, Shrestha S. Intraperitoneal and periportal injection of bupivacaine for pain after laparoscopic cholecystectomy. Kathmandu Univ Med J (KUMJ), 2009, 7(25): 50-53.
6. Thomas S, Beevi S. Epidural dexamethasone reduces postoperative pain and analgesic requirements. Can J Anaesth, 2006, 53(9): 899-905.
7. 馬晨光, 吳秀英. 氟比洛芬酯聯合曲馬多用于腹腔鏡膽囊切除術術后鎮痛. 實用藥物與臨床, 2009, 12(5): 324-326.
8. Balch RJ, Trescot A. Extended-release morphine sulfate in treatment of severe acute and chronic pain. J Pain Res, 2010, 21(3): 191-200.
9. Tuttle CB. Drug management of pain in cancer patients. Can Med Assoc J, 1985, 132(8): 899-900.
10. Budd K. Chronic pain — challenge and response. Drugs, 1994, 47(1): 33-38.
11. Petrella RJ, Disilvestro MD, Hildebrand C. Effects of hyaluronate Sodium on pain and physical functioning in osteoarthritis of the knee: a randomized, double-blind, placebo-controlled clinical trial. Arch Intern Med, 2002, 162(3): 292-298.
12. Kelly S, Dunham JP, Murray F, et al. Spontaneous firing in C-fibers and increased mechanical sensitivity in A-fibers of knee joint-associated mechanoreceptive primary afferent neurones during MIA-induced osteoarthritis in the rat. Osteoarthritis Cartilage, 2012, 20(4): 305-313.
13. Yaksh TL. Pharmacology and mechanisms of opioid analgesic activity. Acta Anaesthesiol Scand, 1997, 41(1 Pt 2): 94-111.
14. Fanelli A, Ghisi D, Pergolotti B, et al. Pilot double-blinded study to assess efficacy and tolerability of morphine sulphate oral solution (Oramorph?) given preoperatively as add-on therapy within a multimodal postoperative pain approach in patients undergoing laparoscopic cholecystectomy. Minerva Anestesiol, 2014, 80(1): 66-75.
15. Silvasti M, Svartling N, Pitk?nen M, et al. Comparison of intravenous patient-controlled analgesia with tramadol versus morphine after microvascular breast Reconstruction. Eur J Anaesthesiol, 2000, 17(7): 448-455.

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硫酸嗎啡口服液在腹腔鏡膽囊手術患者術后鎮痛中的效果觀察

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