摘要
目的探讨氢吗啡酮硬膜外超前镇痛对子宫肌瘤剥除术患者镇痛效果的影响。方法拟在硬膜外麻醉下行子宫肌瘤剥除术患者100例，年龄56—64岁，ASA分级Ⅰ～Ⅱ级，体重指数20～30kg／m2，采用随机数字表法，将其分为两组：氢吗啡酮镇痛组（Q组），硬膜外腔注射罗哌卡因加入氢吗啡酮0．2mg；对照组（D组）硬膜外腔注射罗哌卡因。监测生命体征，记录麻醉后30min（T1）、切皮（T2）、牵拉腹腔（T3）、缝皮（T4）的VAS镇痛评分值和Ramsay镇静评分值，及其他不良反应。如果术中出现低血压，静脉注射去氧肾上腺索0．05mg／次，腹痛严重时追加芬太尼0．05mg／次。术毕记录两组患者芬太尼使用次数；心率、血压异常升高次数。结果两组患者麻醉后30min（T1）、切皮（T2）、牵拉腹腔（T3）时镇痛组的VAS镇痛评分明显低于对照组（P〈0．05），缝皮（T4）时的VAS评分差异无统计学意义；两组患者麻醉后30min（TI）、切皮（T2）的Ramsay镇静评分镇痛组明显高于对照组（P〈0．05），牵拉腹腔（T3）、缝皮（T4）时Ramsay镇静评分差异无统计学意义，镇痛组术中追加芬太尼静脉镇痛次数和心率、血压升高〉基础值20％的次数明显少于对照组，恶心、呕吐发生率差异无统计学意义。结论硬膜外麻醉药物中，首次剂量加入氢吗啡酮协同镇痛，能够提高镇痛效果，不良反应发生率未发现增加。
Objective To evaluate analgesic effects of preemptive epidural analgesia using hydromorphone on patients underwent hysteromyomectomy. Methods 100 ASA Ⅰ or Ⅱ patients aged 55 - 64 years old（ body mass index 20 - 30 kg/m2 ） underwent hysteromyomectomy were randomly divided into two groups with 50 patients in each group. Ropivacaine and hydromorphone （0.2 rag）were injected to epidural space in hydromorphone group （group Q）while only ropivacaine was injected in control group （group D ）. Ramsay scores, VAS scores and other adverse reactions were recorded 30 minutes after epidural anesthesia （ T1 ） , skin incision （ T2 ） , visceral traction （ T3 ） and skin suture （ T4 ）. Phenylephrine （0.05 mg）was injected if blood pressure dropped and fentanyl （0.05 mg）was injected when there was abdominal pain. Times of fentanyl injected, abnormal heart rate and blood pressure were also recorded. Results VAS scores of T1, T2, T3 in group Q were significantly lower than those in group D （ P 〈 0.05 ）. Ramsay scores of T1 and T2 in group Q were significantly higher than those in group D （P 〈 0.05 ）. Times of fentanyl injected, abnormal heart rate and blood pressure in group Q were significantly lower than those in group D （ P 〈 0.05 ）. There were no significant differences in nausea and emesis between the two groups, Conclusion Adding hydromorphone in initial epidural injection may play a cooperative role of enhancing analgesia effects without increasing incidence of adverse reactions.
出处
《医学新知》
CAS
2016年第3期190-192,共3页
New Medicine
关键词
氢吗啡酮
超前镇痛
硬膜外
子宫肌瘤剥除术
镇痛
Hydromorphone
Preemptive analgesia
Epidural anesthesia
Hysteromyomectomy
Analgesia
