王志丰 刘庆德 严英 应向荣

【摘要】目的：探讨阿片类镇痛药体外对精子运动的影响性，以期提高临床用药安全性，降低不良反应。方法：选取2010年7月到2013年1月40例精子活力精液标本，每份分为13份，1份为对照，分别在3种浓度下6种不同阿片类镇痛药在恒温箱孵育4h，运用计算机系统分析精子活力。结果：芬太尼、阿芬太尼、舒芬太尼、布托啡诺在1×10-5mg/mL、2×10-3mg/mL、0.05mg/mL浓度下其精子活力均较对照组低，两者比较差异均有统计学意义（P<0.05）；布托啡诺1×10-5mg/mL与对照组比较差异无统计学意义（P>0.05），而在2×10-3mg/mL、0.05mg/mL比较差异均有统计学意义（P<0.05）；地佐辛在1×10-5mg/mL与对照组比较差异无统计学意义（P>0.05），而在0.05 mg/mL、0.5mg/mL比较差异均有统计学意义（P<0.05）；喷他佐辛在3×10-5mg/mL、0.05mg/mL和对照组比较差异无统计学意义（P>0.05），而在0.5mg/mL时比较差异有统计学意义（P<0.05）。15min后浓度为0.05mg/mL的芬太尼、舒芬太尼、阿芬太尼、布托啡诺、地佐辛中的精子均有衰减现象，舒芬太尼和芬太尼中精子衰减幅度无统计学差异（P>0.05），而它们与布托啡诺、地佐辛和阿芬太尼比较差异均有统计学意义（P<0.05）。结论：低浓度布托啡诺、地佐辛对精子活动无影响，高浓度则完全抑制精子活力，低浓度芬太尼、阿芬太尼、舒芬太尼则显著抑制精子活力，而高浓度喷他佐辛则促进精子活动。

【关键词】阿片类镇痛药；精子活力

Clinical study of opioid analgesic effect on the sperm motility in vitroWANG Zhifeng1， LIU Qingde1， YAN Ying1， YING Xiangrong2. 1. Department of Anaesthesia， Shaoxing Second Hospital， Shaoxing 312000， Zhejiang， China； 2. Department of Urology， Shaoxing Peoples Hospital， Shaoxing 312000， Zhejiang， China

【Abstract】Objectives： To investigate the opioid analgesic effect on sperm motility in vitro in order to improve clinical drug safety and reduce complications. Methods： 40 cases of semen samples from July 2010 to January 2013 were divided into 3 groups， with 13 samples in each group. Respectively， the three groups were incubated for 4h in three concentrations of six different opioid analgesics. Computer systems analysis of sperm motility was done on the samples. Results： Sperm motility of fentanyl， alfentanil， sufentanil， butorphanol at 1 × 10-5mg/mL and 2 × 10-3mg/mL，0.05mg / mL concentration was lower than that in control group， with statistically significant difference （P<0.05）； final concentrations of butorphanol of the two group were 1×10-5mg/mL， without statistically significant difference （P>0.05）. While in the concentration of 2 × 10-3mg/mL， 0.05mg / mL， the differences were statistically significant （P<0.05）； final concentration of Dezocine was 1 × 10-5mg/mL， without statistically significant difference （P>0.05）. In the concentration of 0.05 mg / mL and 0.5mg / mL， the differences were statistically significant （P<0.05）； comparing 3 × 10-5mg/mL， 0.05mg / mL concentration of pentazocine with the control group， the difference was not statistically significant （P>0.05）. Compared with 0.5mg / mL， the differences were statistically significant （P<0.05）. The differences of fentanyl， sufentanil， alfentanil， butorphanol， dezocine in attenuation magnitude of concentration of 0.05mg / mL sperm 15min after the treatment were statistically significant （P<0.05）， but the difference with fentanyl had no significant difference （P>0.05）. Conclusion： The low concentration of butorphanol and dezocine has no effect on sperm motility. High concentration of butorphanol and dezocine can completely inhibit sperm motility. Low concentration of fentanyl， alfentanil and sufentanil significantly suppress sperm motility， and high concentrations of pentazocine can improve sperm motility.

【Key words】Opioid analgesics； Sperm motility

【中图分类号】R9【文献标志码】A

阿片类镇痛药长期服用会产生耐药性和依赖性，对全身多器官、多系统均有明显损害。在临床上对阿片类镇痛药的研究多限于动物试验和长期接触毒品的吸毒者。目前研究证实，长期接触海洛因、吗啡等毒品男性患者的胎儿畸形发生率和中枢神经缺陷发生率明显高于正常人[1]。而就一些急性疼痛需服用阿片类镇痛药的患者来说，阿片类镇痛药的具体药物如阿片受体激动剂、部分激动剂、激动-拮抗药物和拮抗药物对男性生殖系统的影响性是促进还是抑制的目前报道仍较少。本次研究就通过观察对40例需服用阿片类镇痛药的男性进行体外精子运动影响性分析，以期提高用药安全性。

1资料与方法

1.1临床资料

选取2010年7月到2013年1月40例精子活力精液标本，年龄最小21岁，最大35岁，平均（25.1±4.1）岁。……