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| 鞘内注射吗啡用于胸腔镜肺叶切除术患者术后镇痛的半数有效剂量 |
| Median effective dose of intrathecal morphine for postoperative analgesia with thoracoscopic lobectomy |
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| DOI：10.12089/jca.2023.02.008 |
| 中文关键词: 吗啡 镇痛 麻醉 半数有效剂量 鞘内注射 胸腔镜肺叶切除术 |
| 英文关键词: Morphine Analgesia Anesthesia Median effective dose Intrathecal injection Thoracoscopic lobectomy |
| 基金项目:扬州市社会发展项目（YZ2022109） |
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| 中文摘要: |
目的 探讨鞘内注射吗啡（ITM）用于胸腔镜肺叶切除术患者术后镇痛的半数有效剂量（ED50）。
方法 选择拟行全麻下胸腔镜肺叶切除术患者22例，年龄35～64岁，BMI 18～30 kg/m2，ASA Ⅰ或Ⅱ级。所有患者于术前在L2-3间隙行蛛网膜下腔穿刺。患者鞘内吗啡的初始给药剂量为5 μg/kg，相邻药物剂量比值为1∶1.1，剂量梯度依次为5.00、4.55、4.14、3.76、3.42、3.11 μg/kg。根据上一例患者术后镇痛效果，下一例患者上升或下降一个剂量梯度。术后镇痛有效标准：若术后6、12、24、48 h活动时VAS疼痛评分均≤3分，则认为术后镇痛有效；若任一时刻活动时VAS疼痛评分＞3分，则认为镇痛无效。采用Probit法计算ED50、ED95及其95%可信区间（CI）。记录呼吸抑制、恶心呕吐、皮肤瘙痒、尿潴留等不良反应的发生情况。
结果 ITM用于胸腔镜肺叶切除术的ED50为3.468 μg/kg（95%CI 2.926～3.782 μg/kg），ED95为4.037 μg/kg（95%CI 3.746～7.127 μg/kg）。有2例（9%）出现皮肤轻微瘙痒，3例（14%）出现恶心呕吐，未观察到其他不良反应发生。
结论 鞘内注射吗啡用于胸腔镜肺叶切除术的ED50为3.468 μg/kg（95%CI 2.926～3.782 μg/kg）。 |
| 英文摘要: |
Objective To explore the median effective dose (ED50) of intrathecal morphine (ITM) for postoperative analgesia with thoracoscopic lobectomy.
Methods Twenty-two patients scheduled for elective thoracoscopic lobectomy, aged 35-64 years, BMI 18-30 kg/m2, ASA physical status Ⅰ or Ⅱ, were enrolled in this study. All patients underwent subarachnoid puncture at the L2-3 space before surgery. The initial dose of ITM in patients was 5 μg/kg, and the ratio of adjacent drug doses was 1∶1.1. The dose gradients of morphine were: 5.00, 4.55, 4.14, 3.76, 3.42, and 3.11 μg/kg. Depending on the postoperative analgesic effect of the previous patient, the next patient rase or droped by a dose gradient. Effective criteria for postoperative analgesia: if the exercise VAS pain score 6, 12, 24 and 48 hours after operation was all ≤3 points, the postoperative analgesia was considered effective; if the exercise VAS score at any time was >3 points, the analgesia was considered ineffective. The ED50, 95% effective dose (ED95) and 95% confidence intervals (CIs) were calculated using the Probit method. The occurrence of adverse reactions such as respiratory depression, nausea and vomiting, skin itching, and urine retention were recorded.
Results The ED50 of ITM for postoperative analgesia with thoracoscopic lobectomy was 3.468 μg/kg (95% CI 2.926-3.782 μg/kg), and the ED95 was 4.037 μg/kg (95% CI 3.746-7.127 μg/kg). Two patients (9%) had mild skin itching, three patients (14%) had nausea and vomiting, and other adverse reactions were not observed.
Conclusion The ED50 of ITM for postoperative analgesia with thoracoscopic lobectomy was 3.468 μg/kg (95% CI 2.926-3.782 μg/kg). |
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