镁离子对术后病人自控镇痛的疗效观察及对阿片受体介导腺苷酸环化酶活性影响初步研究
摘要
目的
通过双盲随机研究方法评价硫酸镁对吗啡术后镇痛效果的影响；同时观察腹部手术后血清镁离子和钙离子的浓度变化情况。
方法
选择60例接受择期上腹部手术的病人，ASAⅠ—Ⅱ级，随机分为2组：即吗啡组(Group M)和吗啡复合硫酸镁组(Group MM)，Group M中吗啡浓度为0.01mg．kg~(-1)．ml~(-1)，Group MM中吗啡浓度为0.01mg．kg~(-1)．ml~(-1)、硫酸镁浓度为0.6mg．kg~(-1)．ml~(-1)。病人术后自控镇痛采用静脉给药方式(即PCIA，给药模式设置为无连续背景输注、单次给药剂量为1.5ml、锁定时间为5分钟，4小时限制量为36ml)，当患者模拟疼痛评分(VAS)≥2时启动镇痛泵进行自控镇痛，记录开始镇痛治疗后第4h、8h、16h、24h和48h各时间点患者血流动力学情况、疼痛强度及缓解程度、镇静、不适、用药剂量情况及患者对疼痛治疗的总体评价。同时随访并记录患者术后恶心呕吐情况、首次排气时间及其他意外情况。在麻醉诱导前、术后即刻及镇痛治疗结束后取静脉血2ml，测定血清镁离子和钙离子浓度。
结果
在使用PCIA治疗后各观察时间点，吗啡组患者疼痛及感觉不适程度较吗啡复合硫酸镁组严重(P＜0.05)。在疼痛治疗后的第4、8、16、24和48h时Group M药液用量(ml，分别是：12.17±1.14、25.68±3.37、40.21±10.78、57.08±11.19和112.55±19.32)多于Group MM(ml，分别是：10.04±2.65、15.92±4.26、30.83±8.03、47.21±10.89和76.30±16.05)(P＜0.05)。Group MM使用PCIA治疗后，患者疼痛缓解程度较Group M明显，术后胃肠功能恢复较Group M患者要早(P＜0.05)，而两组
PART I
Postoperative pain management with intravenous
patient-controlled morphine: comparison of the effect of adding
sulphate magnesium
OBJECTIVE
To investigate whether the addition of magnesium to morphine for intravenous patient-controlled analgesia will improve analgesic efficacy compared with morphine intravenous patient-controlled analgesia alone after major abdominal surgery. And to test the change of serum magnesium and calcium ion concentrations between pre- and post-major abdominal surgery.
METHODS
Sixty patients were randomly allocated to receive either morphine O.Olmg.kg~(-1).ml~(-1) (Group M) by intravenous patient-controlled analgesia (PCIA), or morphine 0.01mg.kg~(-1).ml~(-1)+MgSO_4 0.6mg.kg~(-1).ml~(-1) (Group MM). Postoperative analgesia was started when the verbal rating scale (VAS) was more than 2. There was no loading dose of the study solution. They were then allowed to use bolus doses of this solution (1.5ml every 5 min, 36ml limited within 4 hours). Discomfort, sedation, pain scores, cumulative morphine consumption and adverse effects were recorded up to 48h after the start of the patient-controlled analgesia. To determine serum magnesium and calcium ion concentrations, blood samples were collected before anesthesia induction, at the end of operation and at the end of patient-controlled analgesia.
通过双盲随机研究方法评价硫酸镁对吗啡术后镇痛效果的影响；同时观察腹部手术后血清镁离子和钙离子的浓度变化情况。
方法
选择60例接受择期上腹部手术的病人，ASAⅠ—Ⅱ级，随机分为2组：即吗啡组(Group M)和吗啡复合硫酸镁组(Group MM)，Group M中吗啡浓度为0.01mg．kg~(-1)．ml~(-1)，Group MM中吗啡浓度为0.01mg．kg~(-1)．ml~(-1)、硫酸镁浓度为0.6mg．kg~(-1)．ml~(-1)。病人术后自控镇痛采用静脉给药方式(即PCIA，给药模式设置为无连续背景输注、单次给药剂量为1.5ml、锁定时间为5分钟，4小时限制量为36ml)，当患者模拟疼痛评分(VAS)≥2时启动镇痛泵进行自控镇痛，记录开始镇痛治疗后第4h、8h、16h、24h和48h各时间点患者血流动力学情况、疼痛强度及缓解程度、镇静、不适、用药剂量情况及患者对疼痛治疗的总体评价。同时随访并记录患者术后恶心呕吐情况、首次排气时间及其他意外情况。在麻醉诱导前、术后即刻及镇痛治疗结束后取静脉血2ml，测定血清镁离子和钙离子浓度。
结果
在使用PCIA治疗后各观察时间点，吗啡组患者疼痛及感觉不适程度较吗啡复合硫酸镁组严重(P＜0.05)。在疼痛治疗后的第4、8、16、24和48h时Group M药液用量(ml，分别是：12.17±1.14、25.68±3.37、40.21±10.78、57.08±11.19和112.55±19.32)多于Group MM(ml，分别是：10.04±2.65、15.92±4.26、30.83±8.03、47.21±10.89和76.30±16.05)(P＜0.05)。Group MM使用PCIA治疗后，患者疼痛缓解程度较Group M明显，术后胃肠功能恢复较Group M患者要早(P＜0.05)，而两组
PART I
Postoperative pain management with intravenous
patient-controlled morphine: comparison of the effect of adding
sulphate magnesium
OBJECTIVE
To investigate whether the addition of magnesium to morphine for intravenous patient-controlled analgesia will improve analgesic efficacy compared with morphine intravenous patient-controlled analgesia alone after major abdominal surgery. And to test the change of serum magnesium and calcium ion concentrations between pre- and post-major abdominal surgery.
METHODS
Sixty patients were randomly allocated to receive either morphine O.Olmg.kg~(-1).ml~(-1) (Group M) by intravenous patient-controlled analgesia (PCIA), or morphine 0.01mg.kg~(-1).ml~(-1)+MgSO_4 0.6mg.kg~(-1).ml~(-1) (Group MM). Postoperative analgesia was started when the verbal rating scale (VAS) was more than 2. There was no loading dose of the study solution. They were then allowed to use bolus doses of this solution (1.5ml every 5 min, 36ml limited within 4 hours). Discomfort, sedation, pain scores, cumulative morphine consumption and adverse effects were recorded up to 48h after the start of the patient-controlled analgesia. To determine serum magnesium and calcium ion concentrations, blood samples were collected before anesthesia induction, at the end of operation and at the end of patient-controlled analgesia.
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