| ObjectiveThrough observing the effect of low - dose naloxone on the analgesic potency of morphine in patient - controlled intravenous analgesia ( PCIA) and on the gastrointestinal motility in patients, to find out the appropriate dose of naloxone that enhance, rather than attenuate the analgesic potency of morphine, reduce Post - operative nausea and vomiting ( PONV) and stimulate the recover}' of gastrointestinal motility, then investigate its possible mechanism.Methods1. General materialsFemale patients that received hysterectomy in spinal - epidural block anesthesia, ASA grade I ~ II ,age 36 ~ 50 years, weight 55 ~ 67kg,height 156 ~ 168cm,choose L2 _ 3 intervertebral space to puncture, 0. 75% ropivacaine 2. 0 ~ 2. 6ml injected in subarachnoid space and 2% lidocaine injected in epidural space, maintain the upper blocking interface in T8 _ 6 level, 48 hours PCIA after operation, patients used the PCA device and carried out VAS score under the instruction of special medical person.2. GroupFour groups divided by random charter method (26 case, each group) : M group (control) : morphine 10 g. kg-1. h-1 together with 1. 25mg droperidol, Saline dilute to 100ml; Group MN0.2, MN0.1, MN0.05 received the same mixturewith group M, but with the addition of naloxone 0. 20 g. kg-1, h-1, 0.10 g. kg-1, h-1 and 0. 05 g. kg-1, h-1 respectively. 0. 10ml/kg analgesic compound as loading dose; 0. 05ml/kg analgesic compound as rescue dose; double blind follow - up 48 hours (if not exhaust in the period, go on observing until first flatus)3. ObservationAfter operation 2,4,6,12,24,36,42 ~48h, record the vital signs, effect of analgesia, sedation score, respiration status, PONV, recovery time of gastrointestinal motility etc by double blind method.4. DetectionPlasm level of opioid peptide, - endorphin( p - EP) , Dynorphin A1-13 ( DYN) , Leu - enkephalin(L - EK) , and motilin in each time spot.5. Statistical analysisChoose SPSS 11.0 software to analyse, mean standard deviation express quantitative data, and use two independent sample t - test or one way analysis of variation ( ANOVA) , then use LSD or SNK test further; Chi - squared test were used in qualitative data, the degree and the incidence of PONV were tested by Kruskal - Wallis test, P<0.05 were considered significant.Results1. Analgesic potencyThe VAS of M group is obviously more effective than MN0.2group in 6h after operation ( P <0.05) ; MN0.05 group is better than M group in 12h after operation (P<0.05); compared between group MN0.05, MN0.2, MN0.1also have significant discrepancy in Statistical treatment (P<0.05 or P < 0.01). The difference in rescue number of patients and population impression Scores is also significant (P<0.05).2. Side - effectsCompared with M group, the symptoms of nausea, vomiting and pruritus is obviously decreased in group MN0.2,MN0.1,MN0.05(P <0. 05). thereinto, the incidence of PONV in each MN group is lower than M group( P < 0.05 ) , the re-covery of intestine sound and the time of the first exhaust is shortened, however, there is not significant discrepancy among group MN0.2, MN0.1, MN0.05 (P>0.05).3. Detection Results3.1 Plasma opioid peptides: The DYN and L - EK of MN0.05 group are higher than M group in both 6h and 12h; M group has a higher level of p - EP at 6h but a lower one at 12h, there is ,to some extent, an decrease of DYN,L -EK and - EP at 42h, but the discrepancy is not significant (P >0.05).3. 2 Plasma Motilin: the level of MOT is increased since the beginning to the end of the operation( P <0.05) , however, there is still a high level of MOT in 24h in M group, and the fastigium is at 24h( compared with the time that operation finished, P <0.01) , the original level is obtained at 42 h; But in group MN0 05, there is a obviously decrease 6h after operation, a measurable increment at 24h and the fastigium at 42h ( compared with that the end of the operation, P < 0. 01 ) ; the discrepancy of 6h,24h,42h are significant between groups (P < 0.05 ). These re...
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