氢吗啡酮在全麻诱导气管插管及术后镇痛中的应用

Clinical study of hydromorphone for tracheal intubation during induction period of general anesthesia and patient-controlled analgesia

目的观察盐酸氢吗啡酮对全身麻醉（全麻）诱导气管插管时应激反应的变化及氢吗啡酮和芬太尼联合用于术后镇痛的临床效果。方法选取择期全麻行口腔颌面部肿物切除术患者60例，美国麻醉医师协会（ASA）分级Ⅰ～Ⅱ级，随机分为氢吗啡酮1组、氢吗啡酮2组和芬太尼组，每组20例。建立静脉通路后，氢吗啡酮1组静脉注射氢吗啡酮0．2mg，氢吗啡酮2组静脉注射氢吗啡酮0．4mg，芬太尼组静脉注射芬太尼0．2mg，5min后常规诱导气管插管。记录患者入室后5min（T0）、插管前即刻（T1）、插管即刻（T2）、插管后1min（T3）、插管后3min（T4）、插管后5min（T5）、插管后10min（T6）7个时间点的平均动脉压（MAP）、心率（HR）等。术后镇痛采用随机数字表分为芬太尼组及氢吗啡酮联合芬太尼组，每组30例。两组均采用患者自控静脉镇痛（PCIA），芬太尼组给予芬太尼1．0mg，氢吗啡酮联合芬太尼组给予氢吗啡酮1．6mg、芬太尼0．5mg，总量150mL，记录术后2、4、8、12、24h各时间点的疼痛视觉模拟评分（VAS）、Ramsay镇静评分（RSS）、PCA按压次数等，观察恶心、呕吐等不良反应发生情况。结果三组患者不同时间点的MAP、HR比较差异均有统计学意义（P〈0．05），且氢吗啡酮2组不同时间点MAP、HR较平稳。术后镇痛两组患者VAS、RSS、PCA有效按压次数比较差异均无统计学意义（P〉0．05），芬太尼组患者不良反应发生率明显高于氢吗啡酮联合芬太尼组，差异有统计学意义（P〈0．05）。结论0．4mg盐酸氢吗啡酮和0．2mg芬太尼均能有效减弱全麻气管插管引起的应激反应，且氢吗啡酮2组患者不同时间点对MAP、HR的影响更小，全麻诱导插管更为平稳。适合用于口腔外科术后镇痛。

Objective To evaluate the effects of of hydromorphone for tracheal intubation during induction peroid of general anesthesia and the efficacy on hydromorhone combined with fentanyl in postoperative patitents. Methods Sixty patients of ASA Ⅰ or Ⅱ, scheduled for elective surgery during oral and maxillofacial tumor resection under general anesthesia,were randomly divided into 3 groups （n= 20 each） using a random number table：low dose hydromorphone group （group HI） ,high dose hydromorphone group （group H2） and fentanyl group（group F）. Hydromorphone0.2 mg,0.4 mg was injected intravenously in group H1 and group H2. Fentany 0.2 mg was infused intravenously in group F. 5 min after intravenous administration, tracheal intubation was performed. The MAP and HR were recorded at 5rain after entering room（T0） ,immediately before intubation （T1）, immediately after intubation （T2） and 1,3,5,10 min after intubation（T3-6）. Patients of postoperative analgesia were randomly divided into two group（n= 30）.. hydromorhone combined with {entanyl group（group H） and fentanyl group（group F）. 2 groups of patients were used with PCIA. The visual scale（VAS） and the scores of sedation with Ramsay was assessed at 2,4,8,12,24 h after operation. Availability press times was compared and side effects such as dizzy,nausea and sedation were observed. Results There were significant differences of MAP and HR in 3 groups at different time point（P〈0.05） ,the values of MAP and HR in group H2 were more stable. About analgesia, VAS, the scores of sedation with Ramsay and availability press times were no significantly difference between the groups（P〈 0.05）. But side-effects were significantly increased in group F compared with group H（P〈0.05）. Conclusion Hydromorphone 0. 4 mg and fentanyl 0.2 ,ng can reduce stress reaction of tracheal intubation,and the change of MAP and HR in group H2 were less. The analgesia efficacy of hydromorhone for maxillofacial surgery was more suitable.