老年人髋关节手术术后使用盐酸氢吗啡酮的合理剂量探讨

Discussion on rational dosage of hydromorphone hydrochloride in theelderly after hip

目的 探讨老年人髋关节手术术后盐酸氢吗啡酮（Hydromorphone hydrochloride,HYD）的合理使用剂量。方法 选取2016年4月~2016年7月江苏大学附属医院收治的全髋置换术老年患者120例,按入院时间随机分为6个组别,每组20例,分别为0.020、0.035、0.050、0.065、0.080和0.095mg/m L组,手术后各组分别给予相应浓度的HYD。观察不同时间各组的血液流变学指标、炎性细胞因子水平、VAS评分和Ramsay镇静评分,记录患者并发症发生情况。结果 术后1d和3d,6组全血黏度和全血还原黏度水平均显著升高（P〈0.05）;随着HYD浓度增加,各组全血黏度和全血还原黏度有降低趋势,与0.020~0.050mg/m L组比较,0.065~0.095mg/m L组水平均较低（P〈0.05）。术后1d和3d,6组炎症因子水平均升高（P〈0.05）;随着HYD浓度增加,炎症因子水平有降低趋势,与0.020~0.050mg/m L组相比,0.065~0.095mg/m L组水平较低（P〈0.05）。随着时间的延长,6组患者VAS评分均有不同程度降低,随着HYD浓度增加,术后不同时间的VAS均有不同程度地降低（P〈0.05）,与0.020~0.035mg/m L组相比,0.050~0.095mg/m L组较低（P〈0.05）。随着时间的延长,0.020~0.035mg/m L组Ramsay镇静评分不同程度升高,0.065~0.095mg/m L组Ramsay镇静评分有不同程度降低,0.050mg/m L组无显著变化。0.050mg/m L组的不良反应发生率最低（P〈0.05）。结论 HYD可用于老年患者接受髋关节手术的术后镇痛,HYD的浓度与镇痛效率相关,建议使用浓度为0.050mg/m L。

Objective To explore the reasonable dose of hydromorphone hydrochloride in the elderly patients after hip surgery. Methods 120 cases of elderly patients who underwent total hip arthroplasty in Affiliated Hospital of Jiangsu University from April 2016 to July 2016 were divided into six groups randomely,with 20 cases each group,they were 0.020,0.035,0.050,0.065,0.080 and 0.095mg/mL group,the corresponding concentrations of HYD were given to each group after surgery,blood rheology, inflammatory cytokine, VAS and Ramsay sedation scores were observed at different time points, Complications were recorded. Results One day and three days after operation,whole blood viscosity and whole blood reduced viscosity level of six groups were significantly increased （^〈0.05）,with the increase of the concentration of HYD,whole blood viscosity and whole blood reducing viscosity of each group decreased,compared with 0.020-0.050 mg/mL group,the 0.065-0.095 mg/mL group was lower （P〈0.05）.One day and three days after operation,the levels of inflammatory cytokines were increased in six groups （P〈0.05）,with the increase of the concentration of HYD,the level of inflammatory factors decreased,compared with 0.020-0.050 mg/mL group,the 0.065-0.095 mg/mL group was lower （P〈0.05）.The VAS scores of six groups were decreased in different degree with the prolongation of time, with the increase of the concentration of HYD,VAS at different time after operation decreased to some extent （P〈0.05）,compared with 0.020-0.035 mg/mL group,the 0.050-0.095 mg/ mL group was lower （P〈0.05）. Ramsay sedation scores increased in 0.020-0.035mg/mL group and decreased in 0.065-0.095mg/mL group,but no significant change in 0.050mg/mL group. The incidence of adverse reactions was the lowest in the 0.050 mg/mL group. Conclusion HYD can be used for postoperative analgesia in elderly patients undergoing hip joint surgery,the concentration of HYD was correlated with the analgesic efficiency, and the recommended concentration was 0.050 mg/mL.