摘要
目的总结氢吗啡酮用于成人术后静脉镇痛(patient-controlled intravenous analgesia, PCIA)的效果和不良反应,寻找适合的PCIA方案。方法选择2016年5月至2017年1月清华大学附属北京清华长庚医院择期行胸腹部、盆腔、脊柱及四肢手术的患者,美国麻醉医师协会(American Society of Anesthesiologists, ASA)分级Ⅰ~Ⅲ级。所有患者采用静脉麻醉诱导,静脉吸入复合麻醉维持。术毕采用PCIA,配方为氢吗啡酮8 mg+昂丹司琼8 mg+生理盐水至100 ml。根据背景量不同随机分为A、B、C 3组,背景量分别为0.16、0.12、0.08 mg/h,患者自控镇痛(patient-controlled analgesia, PCA)单次剂量0.16 mg,锁定时间15 min。术后第1天和第2天,使用数字等级评分法(numerical rating scale, NRS)评估静息及活动疼痛程度、记录PCA有效按压次数及不良反应(恶心呕吐、瘙痒)发生情况。结果纳入的181例患者中,有效病例162例,A组49例,B组61例,C组52例。术后第1天:A、B、C 3组患者静息NRS分别为0.94±0.43、0.97±0.48、1.12±0.62;活动NRS分别为2.49±0.71、2.39±0.78、2.69±0.78;PCA有效按压次数分别为1.0(0.0,14.0)、2.0(0.0,21.0)、1.0(0.0,31.0);恶心呕吐发生情况分别为0(0,2)、0(0,3)、0(0,1)。术后第2天:3组患者静息NRS分别为0.66±0.56、0.72±0.52、1.00±0.66;活动NRS分别为2.06±0.82、2.02±0.83、2.43±0.94;PCA有效按压次数分别为2.0(0.0,13.0)、1.5(0.0,28.0)、1.0(0.0,66.0);恶心呕吐发生情况分别为0(0,2)、0(0,2)、0(0,1)。3组患者术后2 d静息NRS(P=0.483)、活动NRS(P=0.097)、PCA有效按压次数(P=0.092)及恶心呕吐发生情况(P=0.434)的差异均无统计学意义。所有患者未诉瘙痒。结论氢吗啡酮用于PCIA"背景量0.08 mg/h,PCA 0.16 mg,锁定时间15 min"的方案,可为多种类型手术提供良好术后镇痛,未见明显不良反应发生。如患者NRS≥4,可逐渐增加氢吗啡酮的背景量至0.16 mg/h,镇痛效果加强,且不会明显增加不良反应。
Objective To investigate the analgesic effects and adverse reaction of hydromorphone on analgesia in adult patients,and to find the optimal regimen of patient-controlled intravenous analgesia(PCIA).Methods Elective surgical patients who received general anesthesia for chest,abdomen,pelvic,spine or limb operations were enrolled in the study.The patients were randomly divided into three groups.The formula of postoperative PCIA was 8 mg hydromorphone plus 8 mg ondansetron plus normal saline to 100 ml;and the patients of three groups received a continuous basal rate of 0.16,0.12,0.08 mg/h respectively,with the same patient-controlled analgesia(PCA)of 0.16 mg every 15 min as needed.Followed-up on the first and second day after operation,numerical rating scale(NRS)to evaluate resting and activity pain,the press number of PCA and adverse reaction(including nausea,vomiting and pruritus)were recorded.Results A total of 181 patients were enrolled,162 patients were evaluable.There were 49 cases in group A,61 cases in group B,52 cases in group C.The first day after operation:the resting NRS of three groups were 0.94±0.43,0.97±0.48,1.12±0.62;the activity NRS were 2.49±0.71,2.39±0.78,2.69±0.78;the press number of PCA were 1.0(0.0,14.0),2.0(0.0,21.0),1.0(0.0,31.0)and the nausea/vomiting situations were 0(0,2),0(0,3),0(0,1)respectively.The second day after operaion:the resting NRS of three groups were 0.66±0.56,0.72±0.52,1.00±0.66;the activity NRS were 2.06±0.82,2.02±0.83,2.43±0.94;the press number of PCA were 2.0(0.0,13.0),1.5(0.0,28.0),1.0(0.0,66.0)and the nausea/vomiting situations were 0(0,2),0(0,2),0(0,1)respectively.There were no significant differences among the three groups on resting NRS(P=0.483),activity NRS(P=0.097),press number of PCA(P=0.092),or nausea/vomiting situation(P=0.434).No patients complained pruritus.Conclusions In postoperative PCIA,the regimen that basal rate(0.08 mg/h)of hydromorphone with the PCA of 0.16 mg every 15 min as needed can provide good analgesia for various types of operations,a
作者
吉晓琳
张欢
俞晨
张雅慧
高元朝
卢海洋
严思益
段怡
Ji Xiaolin;Zhang Huan;Yu Chen;Zhang Yahui;Gao Yuanchao;Lu Haiyang;Yan Siyi;Duan Yi(Department of Anesthesiology,Beijing Tsinghua Changgung Hospital,School of Clinical Medicine,Tsinghua University,Beijing 102218, China)
出处
《北京医学》
CAS
2019年第1期30-33,共4页
Beijing Medical Journal
关键词
氢吗啡酮
外科
急性术后疼痛
患者自控静脉镇痛
hydromorphone
surgery
acute postoperative pain
patient-controlled intravenous analgesia(PCIA)
