摘要
目的:观察盐酸氢吗啡酮伍用酮咯酸氨丁三醇在老年患者术后经静脉患者自控镇痛(PCIA)中的镇痛效果及不良反应。方法:采用随机数字表法将180例老年胆石症患者分为盐酸氢吗啡酮组(H组)、盐酸氢吗啡酮伍用酮咯酸氨丁三醇组(HT组)和酮咯酸氨丁三醇组(T组),每组60例。镇痛泵配方:H组为6 mg盐酸氢吗啡酮,HT组为3 mg盐酸氢吗啡酮及120 mg酮咯酸氨丁三醇,T组为240 mg酮咯酸氨丁三醇,均以0.9%氯化钠注射液稀释至100 ml。手术结束前15 min,患者均给予负荷量盐酸氢吗啡酮0.2 mg静脉注射,背景输注速度为2.0 ml/h,患者自控镇痛(PCA)剂量为1.0 ml,锁定时间为15 min。记录术后4、8、16、24、36、48 h镇痛(VAS)和镇静(Ramsay)评分及PCAR按压次数,以及恶心、呕吐和皮肤瘙痒发生情况;并分别于术前1 d,术后1、2、7 d采用简易精神状态检查表(MMSE)评估患者认知功能。结果:T组各时间点VAS评分、PCA按压次数均高于H组和HT组(P<0.05);H组各时间点Ramsay评分和术后1、2 d MMSE评分均高于T组和HT组,且恶心、呕吐、皮肤瘙痒发生率更高(P<0.05);各组术后7 d MMSE评分均与术前1 d差异无统计学意义(P>0.05)。结论:盐酸氢吗啡酮伍用酮咯酸氨丁三醇在老年患者腹部手术PCIA中能够达到良好的镇痛效果,且不良反应少。
OBJECTIVE：To evaluate the analgesic effect and side effect of hydromorphone hydrochloride plus ketorolac tromethamine in elder patients undergoing postoperative patient-controlled intravenous analgesia （PCIA）. METHODS： 180 elderly patient with cholelithia were randomly divided into three groups： group H （6 mg hydromorphone hydrochloride） , group HT （3 mg hydromorphone hydrochloride plus 120 mg ketorolac tromethamine） and group T （240 mg ketorolac tromethamine） , of 60 patients in each group. Each therapy was diluted to 100 mL with 0. 9% sodium chloride. At 15 rain before the completion of operation all patients in the three groups were given loading dose hydromorphone （0.2 rag） by intravenous injection at background infusion speed of 2 mL/h, PCA dose of 1 mL, and lockout time of 15 rain. The analgesia （VAS） and sedation （Ramsay） scores at 4, 8, 16, 24, 36 and 48 hrs, the frequency of PCA compression, as well as the occurrence of nausea, vomiting and pruritus and other adverse reactions were recorded ; the cognitive function of the patients was assessed at 1 preoperative day, and 1, 2, and 7 postoperative days using mini mental state examination （MMSE）. RESULTS ： T group had higher VAS scores at each time point and more frequent PCA than in the other groups （ P 〈 0.05 ） ; H group had higher Ramsay scores at each time point and higher MMSE scores at 1 and 2 postoperative days and higher incidence of nausea, vomiting and pruritus compared with other groups （P 〈 0.05 ） ; MMSE scores in each group were not statistically significant at 7 postoperative days compared with at 1 preoperative day （ P 〉 0. 05 ）. CONCLUSIONS ： The use of hydromorphone hydrochloride plus ketorolac tromethamine in PCIA showed satisfactol7 analgesic efficacy and good safety in elderly patients after undergoing abdominal operation undergoing PCIA.
出处
《中国医院用药评价与分析》
2015年第2期177-180,共4页
Evaluation and Analysis of Drug-use in Hospitals of China
