經尿道攝護腺切除術作脊髓麻醉加入小劑是Fentanyl對發抖之影響

The Influence of Small Dose Intrathecal Fentanyl on Shivering during Transurethral Resection of Prostate under Spinal Anesthesia

周譚正(Tam-Ching Chow) ； 卓炳雄(Ping-Hsiung Cho)

《Acta Anaesthesiologica Sinica》 32卷3期 (1994/09) Pp. 165-170

摘要

經尿道攝護腺切除術病人作脊髓麻醉，發抖是很常見之併發症。由於交感神經阻斷，週邊血管擴張及使用冷沖洗液，中樞體溫下降，促使病患發抖之機率升高。發抖引致病人呼吸及心臟排出量增加，心、肺功能不佳者，容易引致嚴重後果。本研究採用隨機雙盲方法，目的為探討經尿道攝護腺切除術病人，以12.5μg/fentanyl作椎管內注射，對發抖發生率及其嚴重程度之影響。在本研究中，有79位病人採隨機雙盲，分成兩組，結果顯示，對照組（38位）中發生率為65.8%，研究組（41位）為12.2%，具統計上差異。同時，發抖分級（1.0 ± 0對1.76 ± 0.7）及發抖累積分數（2.4 ± 0.8對12.5 ± 5.6），研究組均比對照組為低。兩組藥理副作用則沒有顯著差別。本研究結論認為椎管內加入小劑量fentanyl，可以有效減低發抖發生率及減輕其嚴重程度。

關鍵字

Transurethral resection of prostate ； fentanyl ； shivering ； spinal anesthesia

並列摘要

Shivering during spinal anesthesia is a common complication in patients undergoing transurethral resection of prostate. The high incidence of shivering may be due to decreased core temperature secondary to peripheral vasodilation from sympathetic blockade and/or cold irrigation fluid. Shivering is known to increase O_2 consumption, ventilation and cardiac output, which can result in morbidity to patients with limited cardiopulmonary reserves. The aim of this randomized double-blind study was to investigate whether 1.25 μg of intrathecal fentanyl administered would influence the incidence and severity of shivering in patients who underwent TURP under spinal anesthesia. In the present study, 79 patients with (n = 41) or without (n = 38) low dose fentanyl were study. The incidence of shivering was 65.8% in control group and 12.2% in the study group. The difference was statistical significance. The shivering grade (1.0 ± 0 vs 1.76 ± 0.7) and accumulative shivering scores (2.4 ± 0.8 vs 12.5 ± 5.6) were also significantly decreased in the study group (P ＜0.05). Obviously, there was no difference in the incidence of pharmacologic side effect. We concluded that low dose intrathecal fentanyl is a god method for decreasing both incidence and severity of shivering during spinal anesthesia.