盐酸吗啡和盐酸氢吗啡酮用于前列腺电切术后硬膜外镇痛效果的比较

Comparison of Epidural Analgesia Effect Between Morphine and Hydromorphone for Patients after Electrotomy of Prostate

目的 比较盐酸氢吗啡酮与盐酸吗啡在前列腺电切术后患者硬膜外镇痛的效果及不良反应。方法 ASAⅠ或Ⅱ级择期行经尿道前列腺电切术（TURP）患者,随机分为盐酸吗啡组（n=45）,盐酸氢吗啡酮组（n=47）,术后接受硬膜外镇痛。采用视觉模拟（VAS）评分、Ramsay评分评价两组术后6,24 h镇痛、镇静效果及不良反应。结果 6 h内,盐酸氢吗啡酮组患者对疼痛耐受及舒适感优于盐酸吗啡组（P〈0.05）[（2.9±0.3）分比（1.3±0.2）分,（2.4±0.3）分比（0.9±0.2）],而在术后6~12 h盐酸吗啡组患者对疼痛和舒适感受较盐酸氢吗啡酮组好（P〈0.05）[（3.4±0.3）分比（5.4±0.3）分,（3.3±0.2）分比（5.7±0.4）分],24 h后两者效果差异无统计学意义（P〉0.05）;不良反应发生率两者均差异无统计学意义（P〉0.05）。结论 TURP术后硬膜外镇痛,6 h内盐酸氢吗啡酮缓解患者疼痛和舒适感优于盐酸吗啡。

Objective To observe analgesia effect of morphine hydrochloride and hydromorphone hydrochloride in patients after transurethral resection of prostate. Methods Patients after transurethral resection of the prostate （TURP） were randomly divided into 2 groups, morphine hydrochloride group （n=45） and hydromorphone hydrochloride group （n=47）. Analgesia, sedation efficacy and adverse reactions were evaluated at 6 and 24 h after they received epidural postoperative analgesia by using VAS score and Ramsay score. Results In 6 h, hydromorphone hydrochloride group had a better pain tolerance and feeling than morphine hydrochloride group （P〈0.05） [（2.9±0.3） score vs.（1.3±0.2） score, （2.4±0.3） score vs. （0.9±0.2） score].However, in 6-12 h, the results were on the contrary （P〈0.05） [（3.4±0.3） score vs.（5.4±0.3） score, （3.3±0.2） score vs. （5.7±0.4） score].After 24 h, there was no difference between the two groups （P〉0.05）.There were no differences in adverse reactions between the two groups （ P〉0. 05 ） . Conclusion Hydromorphone has a better effect than morphine in epidural analgesia in 6 h.