阿扎司琼预防鞘内吗啡所致瘙痒的临床观察

EFFECTS OF PROPHYLACTIC INTRAVENOUS AZASETRON ON INTRATHECAL MORPHINE-INDUCED PRURITUS

摘要:

目的：观察5-羟色胺（5-HT3）受体拮抗药阿扎司琼静脉预先注射对鞘内吗啡所致的瘙痒发生防治效果。方法：常规腰麻病人150例，随机分为三组。麻醉前20分钟，分别静脉注射阿扎司琼液10mg（A1组，n=50）或20mg（A2组，n=50）。对照组静脉注射等量的生理盐水4ml（C组，n=50）。用0．5％布比卡因和葡萄糖吗啡（0．4mg）混合液2．5ml，行常规腰麻，于注药后2、4、8、24、36、48小时观察并记录病人瘙痒的发生和程度。结果：鞘内吗啡所致的瘙痒发生率，C组82％，A1组62％，A2组48％。A1组和A2组瘙痒发生率明显低于C组（19〈0．05）；C组瘙痒Ⅲ-Ⅳ级共有9例，A1，A2两组瘙痒Ⅲ-Ⅳ级共有0例，两个观察组瘙痒程度明显低于C组（19〈0．05）。而A1组和A2组之间无显著差异。三组瘙痒发生时间基本上类似，集中于8小时内。A1组和A2组持续时间比对照组有减少的趋势，但无显著差异。结论：5-HT3受体拮抗药阿扎司琼可减少鞘内吗啡所致瘙痒的发生和程度。

Abstract:

Objective: To evaluate the effects of prophylactic intravenous administration of the 5-hydroxytryptamine subtype 3(5-HT3) receptors antagonist azasetron on intrathecal morphine-induced pruritus.Methods: 150 patients were randomized into group A1(n=50,azasetron 10 mg,IV),group A2(n=50,azasetron 20 mg,IV) and group C(n=50,normal saline 4 ml).The spinal anesthesia were proceeded with 2.5 ml of 0.5% hyperbaric bupivacaine containing 0.4 mg of morphine in patients with the lower abdomen and the lower limbs surgery. The incidence and severity of pruritus were evaluated at 2,4,8,12,24,36,48 h after intrathecal morphine injection.Results: The incidence and severity of pruritus were significantly lower in group A1 and group A2 than group C(62%,48%,and 82% respectively,P<0.05).Time of occurrence and duration of pruritus were similar in three groups.Conclusion: The prophylactic use of azasetron helps to reduce the incidence and severity of intrathecal morphine-induced pruritus.