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目的：探讨腰硬联合麻醉中静脉输注50 mg/kg和25 mg/kg两种剂量的硫酸镁对术后镇痛和寒战的的影响。方法：90 名腰硬联合麻醉（CSEA）下行全子宫切除术的患者随机分成3组。在腰麻注药后即刻，MGI组30 分钟内静脉输注硫酸镁25 mg/kg继以 10 mg/kg/h 的速度输注至手术结束；MGⅡ组输注硫酸镁50 mg/kg，然后以10 mg/kg/h 的速度输注；C 组注入等量生理盐水。观察术后24 小时的疼痛评分（视觉模拟评分法：VAS），术后镇痛药物的用量，寒战的发生率。结果：三组术后镇痛用药量由低到高依次为MGII组，MGI 组，C 组（P < 0.001）。术后VAS评分，MGII组较C 组减少，（P < 0.05）；在12 h，24 h，MGII组较MGI组减少， MGI组在2 h，4 h较C组减少（P < 0.05）。术后寒战在C 组发生率最高，在MGI组与MGII组发生率少，组间有统计学差异（P = 0.007）。结论：腰硬联合麻醉中静脉输注两种剂量的硫酸镁均可以改善术后镇痛，减少术后寒战的发生率，大剂量硫酸镁更有效，但也可能伴随更大的血流动力学波动。

英文摘要:

Objective:To evaluated the effects of i.v.infusion of magnesium sulphate with two different doses of 50 mg/kg and 25 mg/kg during combined-spinal-epidural-anaesthesia (CSEA) on postoperative analgesia and shivering.Methods:90 patients undergoing abdominal panhysterectomy surgery under CSEA were randomly divided into 3 groups. Just after the intrathecal injection, Group MGI received an iv. MgSO4 of 25 mg/kg within 30 minute, followed by 10 mg/kg/h infusion until the end of operation. Group MGII received 50 mg/kg of MgSO4 followed by 10 mg/kg/h infusion. Group C received an equal volume of physiological saline. Postoperative pain scores (VAS), analgesic consumption, and the incidences of shivering were evaluated.Results:Cumulative postoperative analgesic consumptions was lowest in Group MGII(P<0.001), and highest in group C (P<0.05). VAS was significantly lower in Group MGII than in group C. VAS at 12 h, 24 h after surgery was significantly lower in Group MGII than in group MGI (P<0.05). VAS of Group MGI at 2 h, 4 h after surgery was lower than in group C, (P<0.05 ). The incidences of shivering were lower in group MGI and MGI than in group C (P=0.007).Conclusion:I.V. infusion of magnesium sulphate with two different doses during CSEA improve postoperative analgesia and reduce the incidences of shivering. High dose of magnesium sulphate was more effective, however, the influences on hemodynamics may also increase.

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