氢吗啡酮复合舒芬太尼在骨科手术后静脉自控镇痛中的效果及安全性

Clinical effect and safety of postoperative patient controlled infusion analgesia with hydromorphone combined with sufentanil after orthopaedics surgery

目的探讨氢吗啡酮复合舒芬太尼在骨科手术后静脉自控镇痛(PCIA)中的效果及安全性。方法将100例接受骨科手术的患者随机分为复合组(n=50)和对照组(n=50)。术后均采用PCIA,镇痛时间均为24h。复合组:氢吗啡酮2 mg+舒芬太尼50μg;对照组:舒芬太尼50μg。比较两组术后不同时间的镇痛及镇静效果、PCIA使用情况、不良反应发生率。结果复合组术后2、12、24 h疼痛VAS评分均低于对照组(P<0.05);术后48 h疼痛VAS评分及不同时间Ramsay评分两组之间差异均无统计学意义(P>0.05)。与对照组比较,复合组术后24 h PCIA泵自动进药量、舒芬太尼补充用量明显降低,按压次数、实际有效进药次数也明显减少(P<0.05)。两组不良反应发生率差异无统计学意义(P>0.05)。结论氢吗啡酮复合舒芬太尼在骨科手术术后PCIA对患者具有良好的镇痛、镇静效果,可减少麻醉药物用量,且不增加并发症发生风险。

Objective To explore the clinical effect and safety of postoperative patient controlled infusion analgesia （PCIA） with hydromorphone combined with sufentanil after orthopaedics surgery. Methods The 100 patients who received orthopaedics surgery were randomly divided into combined group （n =50） and control group （n =50）. All the cases were given PCIA after surgery, the analgesia time was 24 h. Control group were given with sufentanil 50 μg, and combined group was given sufentanil 50 μg ＋ hydromorphone 2 mg. The postoperative analgesic and sedative effects at different time, the usage of PCIA and incidence of adverse effects in two groups were compared. Results The VAS after surgery for 2, 12, 24 h in combined group were significantly lower than those in control group （P 〈 0. 05） , while there were no statistical differences on the VAS after surgery for 48 h, Ramsay scores at any time be-tween two groups （P 〉0. 05）. Compared with control group, the PCIA cumulative volume,press numbers, effective numbers and sufentanil supplement at postoperative 24 h in combined group were significantly reduced （ P 〈 0. 05 ）.The adverse reactions in two groups were no statistically different（P 〉0. 05）. Conclusions Postoperative PCIA with hydromorphone combined with sufentanil for orthopaedics surgery can produce good analgesic and sedative effect, re-duce anesthetics dose, and does not increase the risk of complications.