术后镇痛泵引起呼吸困难和肌痉挛3例 Postoperative analgesia pump causing dyspnea and muscle spasm: 3 cases 转载2008-8-1

2008年7月31日我们做了1例“双无”手术，全麻加硬膜外麻醉，术后带上了止痛泵，术后30小时出现恐惧性呼吸困难，阵发性肌紧张，抽搐，全身乏力。马上吸氧，未能缓解，呼吸16次，无三凹征，血氧饱和度正常，心率104次/分，血压120/80mmHg，表现窘迫性呼吸困难征象。

On July 31, 2008, we did a case of "double absence" surgery, general anesthesia plus epidural anesthesia, pain relief pump after surgery, panic breathing difficulties, paroxysmal muscle tension, convulsions, and general weakness for 30 hours after surgery. Immediately absorbed oxygen, failed to ease, breathing 16 times, no three recesses, normal blood oxygen saturation, heart rate 104 times per minute, blood pressure 120/80 mmHg, showing signs of dyspnea.

立刻停用止痛泵，给与高糖和吸氧后逐渐缓解。刚刚处理好一个，2008年8月1日做的另一个“双无”，术后才6个小时，也出现了呼吸困难，觉得空气缺少，憋闷难忍，烦热不已，有了上例经验，立刻停用止痛泵，症状很快缓解。 2008年8月2日晚又有一例带泵角弓反张的，停泵后逐渐缓解。

Stop the pain pump immediately and gradually ease after giving high sugar and oxygen absorption. Just dealt with one, August 1, 2008, another "double nothing", only 6 hours after the surgery, but also difficult to breathe, feel the lack of air, unbearable, irritated, with the above example experience, immediately Stop the pain pump, symptoms quickly ease. On the evening of August 2, 2008, there was another case with a pump angle bow, which gradually eased after stopping the pump.

讨论：止痛泵内药物有利多卡因和吗啡等药物，可能是吗啡的副作用，抑制了呼吸中枢，加上平面较高，导致呼吸肌运动障碍，呼吸困难。处理是停用痛泵，重者给与阿托品等对抗，特别重的应该上呼吸机，如果误诊会很危险。

Discussion: analgesics in the pump, which may be a side effect of morphine, may inhibit the respiratory center, plus the higher plane, leading to dyspnea and difficulty in breathing. The treatment is to stop the pain pump, and the heavy ones are given to confrontation with atropine, etc.. The special weight should be on the ventilator, and it will be dangerous if misdiagnosed.

预防：不要放吗啡和新斯的明等，而且平面低一些为好。

Precautions: do not put morphine and Xinfen, and lower plane is better.