[鞘内哌哌啶减轻脊髓麻醉引起的寒战]。

J C Chen, S W Hsu, L H Hu, Y J Hong, P S Tsai, T C Lin, C F Lin, T T Wei
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摘要

寒战是一种常见而复杂的现象,发生在许多患者在脊髓麻醉。颤抖可以使耗氧量增加500%,这可能对心肌储备减少的患者有害。寒战的代谢成本和心肺后果对贫血、冠状动脉疾病、心肺功能不全、身体虚弱或老年人尤为重要。研究鞘内哌哌啶是否能预防脊髓麻醉后的寒战。60例ASA I-II级患者分为鞘内哌哌啶组(n = 30)和对照组(n = 30)。ⅰ组给予脊柱丁卡因12 ~ 16 mg,加哌啶0.2 mg/kg;ⅱ组给予脊柱丁卡因12 ~ 16 mg,不加哌啶。记录两组患者术中最高麻醉水平、环境温度和直肠温度、血压(BP)和心率(HR)、有无寒战、寒战强度。术后密切观察不良反应。与II组(56.7%)相比,I组患者的寒战发生率(16.7%)显著降低(p < 0.005)。除恶心外,其他轴向阿片类药物没有或较少观察到副作用。结论鞘内哌哌啶能抑制脊髓麻醉引起的寒战。
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[Intrathecal meperidine attenuates shivering induced by spinal anesthesia].

Shivering is a common and complex phenomenon that occurs in many patients during spinal anesthesia. Shivering can increase oxygen consumption up to 500 per cent which may be detrimental to patients with decreased myocardial reserve. The metabolic costs and cardiorespiratory consequences of shivering are important particularly for patients with anemia, coronary arterial disease, cardiopulmonary insufficient, debilitated status or are elderly. We studied whether intrathecal meperidine could prevent shivering after spinal anesthesia. 60 patients with ASA class I-II were divided into intrathecal meperidine group (Group I) (n = 30) and control group (Group II) (n = 30). Group I received spinal tetracaine 12-16 mg with meperidine 0.2 mg/kg and Group II received spinal tetracaine 12-16 mg without meperidine. During operation the highest level of spinal anesthesia, ambient and rectal temperatures, blood pressure (BP) and heart rate (HR), presence or absence of shivering, intensity of shivering in both groups were recorded. Close observation for side effects was given post-operatively. There was a significant reduction (p < .005) in incidence of shivering in group I patients (16.7%) when compared with group II (56.7%). There was no or less side effects observed with other neuraxial opioids except nausea. We concluded that intrathecal meperidine could suppress shivering induced by spinal anesthesia.

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