盐酸纳布啡联合吗啡用于髋关节置换术后静脉自控镇痛的临床观察

Effect of nalbuphine hydrochloride combined with morphine for patient accepted intravenous control analgesia after hip arthroplasty surgery

目的观察纳布啡联合吗啡用于髋关节置换术后静脉自控的镇痛效果。方法选择在我院行髋关节置换术且要求术后镇痛的患者60例,分为吗啡对照组和吗啡-纳布啡观察组,各30例。所有患者术毕经上肢静脉通道连接GEMSTAR 13087型精密型镇痛泵,对照组镇痛泵配方为:吗啡35mg+托烷司琼10mg+生理盐水至150ml;观察组镇痛泵配方为:吗啡35mg+纳布啡20mg+托烷司琼10mg+生理盐水至150ml。持续背景剂量输注2ml/h,单次按压剂量0.5ml,锁定时间20min。观察记录两组患者手术时间,术后2h、4h、8h、12h、24h及48h时的MAP、HR及VAS评分、Ramsay镇静评分、48h内按压次数以及不良反应的发生情况。结果观察组术后各时点的MAP和HR明显低于对照组(P<0.05)。观察组术后4h、8h、12h、24h、48h时的VAS评分低于对照组(P<0.05)。两组患者各时点Ramsay镇静评分无统计学差异(P>0.05)。观察组术后48h内平均按压次数明显少于对照组(P<0.05)。观察组的皮肤瘙痒、恶心呕吐及头晕的发生率明显低于对照组(P<0.05)。结论纳布啡联合吗啡用于髋关节置换术后患者静脉自控镇痛安全有效,镇痛满意度高,不良反应发生率低。

Objective To investigate 出e effect of nalbuphine hydrochloride combined with morphine for patients accepted intravenous control analyesia after hip arthroplasty. Methods 60 patients required hip arthroplasty surgery and postoperative analgesia were divided into two groups ： morphine group （control group） and morphine combined with nalbuphie group （observation group）, each group contained 30 patients. After surgery, all the patients were connected with GEMSTAR 13087 precision type analgesia pump through upper venous extremity channel, the control group analgesic pump formula ： morphine 35mg ＋ tropisetron lOmg diluted to 150ml by 0.9% NaGl,the observation group analgesic pump formula ： morphine 35mg ＋ nalbuphine 20mg ＋ tropisetron lOmg diluted to 150ml by 0.9% NaCl. Maintain dose was 2ml/h, single press dose was 0.5ml, lock time was 20min. Observed and recorded the operation time of the two groups, the MAP, HR, VAS score, Ramsay sedation score at 2h, 4h, 8h, 12h, 24h and 48h after operation, the number of pressing times in 48h and the occurrence of adverse reactions. Results The MAP and HR at each time after surgery in observation group was significantly lower than control group （P〈0.05）. The VAS score in observation group was less than control group at 4h, 8h, 12h, 24h, 48h after surgery （P〈0.05 ）.There was no significant difference in Ramsay sedation score at each time between the two groups （P〉0.05）. The average pressing times of observation group was significantly less than control group at 48h after surgery （P〈0.05）. The incidence of skin itching, nausea, vomiting and dizziness in the observation group was significantly lower than those in control group （P〈0.05） . Conclusion Nalbuphine combined with morphine used for patient controlled intravenous analgesia after hip arthroplasty surgery is safe and effective, analgesic satisfaction is high, the adverse occurrence rate is low.