鞘内注射哌替啶可减少脊麻剖腹产寒颤发生率

由脊麻引起的术中寒颤可使人感到不适，并影响麻醉监测。因此，加拿大学者Roy JD博士及其同事进行了一项随机双盲前瞻性研究，观察鞘内注射哌替啶（0.2mg/Kg）是否可以减少脊麻下剖腹产寒颤的发生率和强度。

40名行非急诊剖腹产手术的产妇被分为两组。脊麻药物采用重比重布比卡因（0.75；10.5mg）和吗啡0.15mg。此外，实验组加用哌替啶（0.2mg/Kg），对照组加用生理盐水。实验中需观察的数据包括感觉阻滞平面、血压、中心温度和寒颤强度。首先每分钟记录这些数据共记录10分钟，然后每3分钟一次记录33分钟，再每5分钟一次直到感觉平面消退至L4。

研究结果显示，两组到达最高感觉平面的时间、最大阻断节段数、感觉和运动阻滞平面的消退情况和收缩压均无明显差异。而哌替啶组的寒颤发生率（P<0.02）和寒颤强度（P<0.003）均降低。

Roy博士等认为，鞘内注射哌替啶0.2mg/kg可减少脊麻下剖腹产寒颤的发生率和寒颤强度。

Anesth Analg. 2004 Jan;98(1):230-4, table of contents.

Intrathecal meperidine decreases shivering during cesarean delivery under spinal anesthesia.

Roy JD, Girard M, Drolet P.

Departement d'Anesthesiologie, Hopital Maisonneuve-Rosemont, Universite de Montreal, 5415 Boul l'Assomption, Montreal, Quebec, Canada H1T 2M4.

Shivering associated with spinal anesthesia is uncomfortable and may interfere with monitoring. We performed this prospective, double-blinded, and randomized study to determine whether intrathecal meperidine (0.2 mg/kg) decreases the incidence and intensity of shivering after spinal anesthesia for cesarean delivery. Forty parturients scheduled for nonemergent cesarean delivery were enrolled in two groups. Spinal anesthesia consisted of hyperbaric bupivacaine (0.75%; 10.5 mg), morphine 0.15 mg, and, in the experimental group, meperidine (0.2 mg/kg) or, in the control group, normal saline. Data collection, including sensory block level, blood pressure, core temperature, and shivering intensity, was performed every minute for 10 min, every 3 min for 33 min, and then every 5 min until the sensory level receded to L4. Time to highest sensory level, maximum number of blocked segments, sensory and motor blockade regression, and systolic blood pressure showed no difference between groups. The incidence of shivering was less (P < 0.02) in the meperidine group, as was its intensity (P < 0.003). Intrathecal meperidine (0.2 mg/kg) is effective in reducing the incidence and intensity of shivering associated with spinal anesthesia for cesarean delivery. IMPLICATIONS: Previous studies have suggested that IV meperidine is helpful for treating intraoperative shivering. This study was undertaken to evaluate spinal meperidine and found that it decreases the incidence and intensity of shivering associated with spinal anesthesia for cesarean delivery.

欢迎医学空间注册用户来信索取原文