氢吗啡酮在骨科术后镇痛中应用的有效性和安全性

Efficacy and safety of hydromorphone for postoperative analgesia in orthopedics

目的评估氢吗啡酮用于骨科术后镇痛的有效性和安全性,并与传统强阿片药舒芬太尼的镇痛效能和副作用进行比较。方法全麻下行骨科手术、术后接受24小时自控静脉镇痛患者114例。将114例患者随机分为氢吗啡酮组和舒芬太尼组,镇痛药液包含0.16 mg/ml盐酸氢吗啡酮或1μg/ml枸橼酸舒芬太尼。记录患者性别、年龄、身高、体重、手术部位、后静脉镇痛期间、记录用药剂量、静止和运动疼痛评分、镇静评分、心率、血压、脉搏氧饱和度以及不良反应。结果氢吗啡酮组患者术后各个时点患者心率(80±15)次/分,收缩压(113±15)mmHg,舒张压(65±10)mmHg,脉搏氧饱和度(98±1)%,两组比较差异无统计学意义。术后6小时氢吗啡酮组VAS评分低于舒芬太尼组,而术后18小时、24小时氢吗啡酮组VAS评分高于VAS组。术后6小时、18小时和24小时氢吗啡酮组PCA按压次数和药物用量均高于舒芬太尼组。两组患者以上指标比较差异无统计学意义。两组患者Ramsay镇静评分均为2(2,2),也未出现术后镇痛相关的呼吸抑制。氢吗啡酮组患者术后恶心呕吐和眩晕的发生率分别为7.1%和1.9%,与舒芬太尼组比较差异无统计学意义。两组患者对术后镇痛的满意度均为5(4,5)。结论氢吗啡酮可以安全有效地用于成人骨科术后静脉自控镇痛,0.16mg/ml盐酸氢吗啡酮与1μg/ml枸橼酸舒芬太尼的镇痛效能和不良反应相似。

[Objective] To evaluate the efficacy and safety-- of postoperative analgesia by hydro- morphone in orthopedics, compare the benefit in analgesia and the side effect profile of hydromorphone with sufentanil. Methods Patients receiving orthopedic surgery under general anesthesia with postopera- tive patient-controlled intravenous analgesia （ PCIA ） for 24 hours during the period between December 2014 and April 2015 were included. Patients were assigned randomly to receive either ydromorphone （0.16 mg/ml）or sufentanil（ 1 p^g/ml）PCA after surgery. Patient data including sex, age, height, weight, and operation site were collected. Total analgesia consumption, pain scores at rest and during movement, sedation score, heart rate, blood pressure,oxygen saturation,adverse effects and patient satisfaction was recorded during the PCIA course. Results A total of 114 patients were included in the analysis. Patients had heart rate of（ 80 ± 15 ） bpm, systolic blood pressure of（ 113± 15 ） mmHg, diastolic blood pressure of （65 ±10） mmHg and pulse oxygen saturation of（98 ± 1 ） % during hydromorphone PCIA course. But there was no statistically significant difference between the hydromorphone and sufentanil groups. Patients in the hydromorphone group had lower VAS scores at 6h, higher VAS scores at 18 h and 24 h, more PCA device and close requirements at 6 h, 18 h and 24h after surgery than patients in the sufentanil group. There was also no statistically significant difference between the two groups. Patients in two groups had Ramsay sedation score of 2 （2,2）and no respiratory depression related with excessive sedation. Among adverse effects of PC1A in the hydromorphone group,nausea and vomiting had the incidence of 7. 1% and dizziness of 1.9%. There was no statistically significant difference compared with the sufentanil group. In general, patient satisfaction with postoperative analgesia in two groups was both 5 （4,5）during PCIA course. Conclusion hydromorphone PCIAis safe and effective for postoperative analgesia after orthopedic surgery. The benefit in analgesia and the side effect profile of 0.16mg/ml hydromorphone and 1 ~g/ml sufentanil are equal.