Preoperative lumbar epidural morphine improves postoperative analgesia and ventilatory function after transsternal thymectomy in patients with myasthenia gravis.
Preoperative lumbar epidural morphine improves postoperative analgesia and ventilatory function after transsternal thymectomy in patients with myasthenia gravis.
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术前腰椎硬膜外吗啡可改善重症肌无力患者经胸骨胸腺切除术后的镇痛和通气功能。
DOI：
10.1097/00003246-199112000-00006
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发表时间：
1991
影响因子：
8.8
通讯作者：
Bulkley,GB
中科院分区：
文献类型：
--
作者：
Kirsch,JR;Diringer,MN;Borel,CO;Hanley,DF;Merritt,WT;Bulkley,GB
目的：为了检验术前腰硬膜外吗啡改善重症肌无力患者经胸骨胸腺切除术后疼痛控制和排便功能的假设，设计：研究设计为随机、安慰剂对照和双盲。设置：手术后，所有患者均进入神经科学重症监护室进行评估和治疗。患者：所有到医院接受胸腺切除术的重症肌无力患者都被要求参加这项研究。20例患者随机分为安慰剂组或硬膜外吗啡groups.Interventions：患者接受硬膜外吗啡（7毫克在14毫升的无菌生理盐水）或生理盐水（14毫升）麻醉诱导前。术中给予静脉补充阿片类药物，需要由麻醉师决定。主要结果指标：主要结果指标是术后疼痛的指标（例如，视觉模拟疼痛评分、需要补充阿片类药物、呼吸频率）和排尿功能（例如，用力肺活量、负吸气压）。结果：术后即刻，安慰剂组的视觉模拟疼痛评分是硬膜外吗啡组评分的两倍（安慰剂组7.0+/-PT 1.3;硬膜外吗啡组3.5+/-PT 1.2，p<. 05）。在术后前8小时，安慰剂组需要更多的阿片类药物（0.22+/-PT 0.03 vs. 0.12+/-PT 0.04 mg/kg吗啡当量，p<0.05）。06)比硬膜外吗啡组好。后来，两组接受了类似数量的阿片类药物。接受硬膜外吗啡的患者有更好的用力肺活量的初始恢复（在8小时：术前值的55+/-PT 6%[硬膜外吗啡对34+/-PT 5%[安慰剂]，p<0.05）。05）。硬膜外吗啡组术后前12小时呼吸率较低，Paco 2无差异。术后插管或ventilation.Conclusions：术前腰硬膜外吗啡有利于术后镇痛，提高初始术后镇痛性能的持续时间组之间没有差异。(C)威廉姆斯&威尔金斯1991.保留所有权利。
Objective: To test the hypothesis that preoperative lumbar epidural morphine improves postoperative pain control and ventilatory function after transsternal thymectomy in patients with myasthenia gravis.Design: The study design was randomized, placebo-controlled, and double-blind.Setting: After surgery, all patients were admitted to the Neuroscience Critical Care Unit for evaluation and treatment.Patients: All patients with myasthenia gravis who presented to the hospital for thymectomy were asked to participate in the study. Twenty patients were randomized to either the placebo or epidural morphine groups.Interventions: Patients received either epidural morphine (7 mg in 14 mL of sterile saline) or saline (14 mL) before induction of anesthesia. Supplemental iv opioids were administered intraoperatively, with need determined by the anesthesiologist.Main Outcome Measures: The main outcome measures were indicators of postoperative pain (eg, Visual Analog Pain Score, requirement for supplemental opioid administration, respiratory rate) and ventilatory function (eg, forced vital capacity, negative inspiratory pressure).Results: Immediately after surgery, the Visual Analog Pain Score in the placebo group was twice as high as the score in the epidural morphine group (placebo 7.0+/-PT 1.3; epidural morphine 3.5+/-PT 1.2, p<. 05). During the first eight postoperative hours, the placebo group required more opioids (0.22+/-PT 0.03 vs. 0.12+/-PT 0.04 mg/kg morphine equivalents, p<. 06) than the epidural morphine group. Later, both groups received similar amounts of opioids. Patients receiving epidural morphine had better initial recovery of forced vital capacity (at 8 hrs: 55+/-PT 6%[epidural morphinel vs. 34+/-PT 5%[placebo] of preoperative value, p<. 05). Respiratory rate was lower for the first 12 postoperative hours in the epidural morphine group, without a difference in Paco2. There was no difference between groups for the duration of postoperative intubation or ventilation.Conclusions: Preoperative lumbar epidural morphine facilitates postoperative analgesia and improves initial postoperative ventilatory performance.(C) Williams & Wilkins 1991. All Rights Reserved.Article Tools