不同剂量氢吗啡酮用于成人腹腔镜术后镇痛的效果与安全性

Safety and efficacy of different dosage of hydromorphone as postoperative analgesic for adults with laparoscopic surgery

目的探讨氢吗啡酮用于成人腹腔镜术后单次镇痛的合适剂量,观察其有效性及安全性。方法选择择期行腹腔镜手术患者60例,年龄22~67岁,随机分为A组（氢吗啡酮0.005 mg/kg）、B组（氢吗啡酮0.007 5 mg/kg）和C组（氢吗啡酮0.01 mg/kg）,每组20例。手术结束前30 min静脉注射氢吗啡酮,分别记录三组患者的自主呼吸恢复时间、呼之睁眼时间、拔管时间,基础、拔管时和拔管后15 min、30 min各时间点患者的心率（HR）、平均动脉压（MAP）、呼吸频率（RR）和脉搏血氧饱和度（Sp O2）,以及拔管后15 min、30 min、1 h、2 h、4 h各时间点患者的镇痛评分（VAS）、镇静评分（Ramsay）和不良反应。结果自主呼吸恢复时间、呼之睁眼时间、拔管时间及拔管、术后各时间点的RR和Sp O2三组间比较差异均无统计学意义（P〉0.05）。拔管时、拔管后15 min、30 min的HR比较,B、C组均低于A组,差异均有统计学意义（P〈0.05）。拔管时、拔管后15 min、30 min的MAP比较,C组均低于A、B组,差异均有统计学意义（P〈0.05）。术后各时间点VAS评分比较,B、C组均低于A组,C组低于B组,差异均有统计学意义（P〈0.05）。术后15 min、30 min、1 h的镇静评分比较,B、C组均比A组高,差异均有统计学意义（P〈0.05）。不良反应发生例数三组间比较差异无统计学意义（P〉0.05）。结论手术结束前30 min单次静脉注射氢吗啡酮0.01 mg/kg是用于成人腹腔镜术后单次镇痛的合适剂量。

Objective To investigate the appropriate dosage of hydromorphone as postoperative analgesic for adult with laparoscopic surgery, and to observe its efficacy and safety. Methods Sixty patients, aged from 22 to 67, who were scheduled for selective laparoscopic surgery, were randomly divided into group A （hydromorphone 0.005 mg/kg, n=20）, group B （hydromorphone 0.007 5 mg/kg, n=20） and group C （hydromorphone 0.01mg/kg, n=20）. Hydromorphone was intravenously injected at thirty minutes before the surgery ends. The recovery time of spontane-ous respiration, time of eye opening and extubation, and the HR, MAP, RR, SpO2 at the time of baseline, extubation, 15 min and 30 min after surgery were recorded respectively. Visual analog scale （VAS）, sedation score （Ramsay） and adverse effect at the time of 15 min, 30 min, 1 h, 2 h, 4 h after surgery were also recorded. Results There was no sta-tistically significant difference among three groups in the times of spontaneous respiration, eye opening, extubation, and in the RR, SpO2 at the time of extubation and each time points after surgery （P〉0.05）. The HR at the time of extu-bation, 15 min, 30 min after surgery in group B and group C were lower than those in group A. The differences were statistically significant （P〈0.05）. The MAP at the time of extubation, 15 min, 30 min after surgery in group C were lower than those in group A and group B （P〈0.05）. The VAS score at five time points after surgery in group B and group C were lower than those in group A, and the VAS score at five time points after surgery in group C was lower than those in group B （P〈0.05）. The Ramsay score at the time of 15 min, 30 min, 1 h after surgery in group B and group C were higher than those in group A （P〈0.05）. There was no statistically significant difference among three groups in inci-dence of adverse effect （P〉0.05）. Conclusion As postoperative analgesic, the appropriate dosage of intravenous hydro-morphone for adults with laparoscopic surgery was 0.01 mg/kg at 30 minutes before the end of surgery.