摘要
目的 探讨氢吗啡酮静脉超前镇痛对全麻患者苏醒期躁动及术后镇痛的影响. 方法 择期全麻下行肺叶切除术患者40例,年龄55～64岁,体重指数18～24 kg/m2 ,ASAⅠ～Ⅱ级. 采用随机数字表法,将其随机分为2组. 对照组即术后全凭静脉镇痛组（A组）,插管后皮下注射生理盐水2 mL;超前镇痛组（B组）患者插管后皮下注射氢吗啡酮2 mL （2 mg）. 术中持续泵注瑞芬太尼0.2 μg/（min·kg）,异丙酚0.2 mg/（min·kg）,根据肌松情况术中间断推注苯磺酸顺式阿曲库铵0.1 mg/kg. 静脉镇痛泵用100 μg舒芬太尼加生理盐水稀释至100 mL,手术结束后开始全凭静脉自控镇痛（ PCIA）：首次剂量2 mL,持续输注2 mL/h,自控给药量1 mL/次,锁定时间30 min,极限量6 mL/h. 记录两组患者手术后呼吸恢复时间,拔管时间,拔管时心率、收缩压,躁动评分（ RS） ,24 h内VAS镇痛评分、Ramsay镇静评分. 结果 两组患者的呼吸恢复、手术后拔管时间与Ramsay镇静评分比较差异无统计学意义（P〉0.05）. B组苏醒期心率、收缩压低于A组,躁动评分低于A组,两组比较差异有统计学意义（P〈0.05）. 术后1、2 h,B组的VAS评分低于A组（P〈0.05）,其余时间两组VAS评分比较差异无统计学意义（P〉0.05）. 结论 术前皮下注射氢吗啡酮可减轻全麻患者术后苏醒期躁动,血流动力学稳定,与对照组比较,镇静效果无明显差异,而术后2h内镇痛效果较好.
Objective To evaluate the preemptive analgesia effects of hydromorphone on emergence agitation and postoperative analgesia in patients with general anesthesia. Methods Forty ASAⅠorⅡpatients aged 55～64 years old with BMI 18～24 kg/m2 undergoing pulmonary lobectomy were randomly divided into 2 groups：Patient controlled intraveneous analgesia （ PCIA） group （ group A） was given subcutaneous injection of normal saline 2 mL after intuba-tion,hydromorphone group （group B） was given subcutaneous injection of hydromorphone 2 mL （2 mg） after intuba-tion. Remifentanil was injected with micro perfusion pump by 0.2 μg/（ min·kg） ,propofol was injected with micro per-fusion pump by 0.2 mg/（ min·kg） ,cisatracurium was injected discontinuously. After operation,PCIA started：100 μg sufentanil was diluted in normal saline （100 mL）. The first dose of injection was 2 mL with continuous injection dos-age of 2 mL/h,the controlled dosage by patients was 1 mL per time,the locking time was 30 min,and limited dose was 6 mL/h. The time of postoperative respiratory recovery and extubation,systemic blood pressure and heart rate after ex-tubation,agitation scores, Ramsay scores and VAS with in 24 h were recorded. Results There was no significant difference in the postoperative respiratory recovery time,extubation time and Ramsay scores between the two groups （ P〉0.05）. The heart rate,systemic blood pressure and agitation score after extubation in group B were lower than those of group A （P〈0.05）. The VAS scores of group B were lower than those of group A at 1,2 h after operation （P〈0.05）. Conclusion Preemptive analgesia with hydromorphone can improve the emergence agitation of patients with general anesthesia,the hemodynamics is stable with better analgesia effect within 2 h after operation （ compared with control group） ,and has good sedation effect.
出处
《实用药物与临床》
CAS
2015年第9期1062-1065,共4页
Practical Pharmacy and Clinical Remedies
关键词
氢吗啡酮
超前镇痛
苏醒期躁动
术后镇痛
镇静
Hydromorphone
Preemptive analgesia
Emergence agitation
Postoperative analgesia
Sedation
