阿片类镇痛药与局麻药联合应用于椎管内麻醉的研究进展

摘要/Abstract

摘要： 尽管在某些手术中椎管内麻醉具有许多潜在的优势,但是也存在许多潜在的缺点,比如由于交感神经阻滞导致的低血压、剂量过大导致药物毒性、以及引起患者恶心和呕吐等等。近期有研究表明，鞘内联合应用阿片类药物和局麻药可以产生明显的协同效应,极低浓度的局麻药联合阿片类药物能大大增强镇痛效果。有报道称阿片类镇痛药辅助应用于椎管内麻醉可以加强神经阻滞，延长感觉和运动神经阻滞的持续时间，提高术中区域麻醉的镇痛效果，延长术后镇痛时间，降低局部麻醉的剂量。因此,为了避免椎管内麻醉相关的不良反应,阿片类镇痛药常作为一种添加剂应用于椎管内麻醉中。通过结合其受体，阿片类药物可以刺激内源性阿片肽的释放,它还可以抑制交感神经以减少去甲肾上腺素的释放,所以它可以提高人体疼痛的阈值，起到麻醉作用。

关键词: 阿片类止痛药, 局麻药, 椎管内麻醉

Abstract: Though intravertebral anesthesia has numerous potential advantages in some surgeries, unfortunately it has numerous potential disadvantages, such as potential hypotension due to sympathetic block, and potential toxicity, nausea and vomiting and so on. Recent experiments showed that the combined application of intrathecal opioids and regional anesthetics can produce obvious synergistic effect- extremely low concentrations of regional anesthetics combined with opioids greatly enhance the analgesic effect. There are reports of opioid analgesics administered combined with intravertebral can be added for nerve block and in regional anesthetic which can prolong the duration of sensory and motor nerve block, enhance the regional anesthetic analgesic effect during operation, prolong the time of postoperative analgesia, and decrease the dose of regional anesthetic. Thus, in an attempt to avoid unpleasant side-effects associated with intravertebral anesthesia, opioid analgesics administered intravertebrally has been offered to patients as an additive to intravertebral anesthesia. Binding to its receptor，opioids can stimulate the release of endogenous opioid peptides, it can also inhibit the sympathetic nerve to reduce the release of norepinephrine，so it can enhance the threshold of body pain．

Key words: Opioid Analgesics, Regional Anesthetic, Intravertebral Anesthesia

奚丰张晓庆. 阿片类镇痛药与局麻药联合应用于椎管内麻醉的研究进展[J]. 外科研究与新技术, 2017, 6(1): 48-52,59.

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