氢吗啡酮对瑞芬太尼复合麻醉所致术后痛觉过敏的预防作用研究

Prevention of hydromorphone on postoperative hyperpathia in patients receiving remifentanil combined anesthesia

目的 探讨氢吗啡酮对瑞芬太尼复合麻醉所致术后痛觉过敏（RIH）的预防效果.方法 将64例择期行腹部手术及术后镇痛的患者采用随机数字表法分为两组各32例.两组术后均采用患者静脉自控镇痛（PCIA）,对照组：芬太尼12.5μg/kg;氢吗啡酮组：氢吗啡酮10μg/kg＋芬太尼12.5μg/kg.比较两组术后不同时间的镇痛效果,术后恢复情况及PCIA使用情况、不良反应发生率.结果 两组呼吸恢复时间、唤醒时间、拔管时间差异均无统计学意义（t=1.21、0.83、0.33,均P〉0.05）,氢吗啡酮组拔管时MAP、HR显著低于对照组（t=2.84、2.66,P〈0.05）;氢吗啡酮组术后30 min、1 h、2 h、4 h、12 h VAS评分均明显低于对照组（t=8.83、5.25、8.77、9.51、9.69,均P〈0.05）,两组术后24 h VAS评分差异无统计学意义（t=1.87,P〉0.05）;与对照组比较,氢吗啡酮组术后1 h、24 h按压次数、芬太尼用量均明显减少（t=16.71、36.38、43.05、10.98,P〈0.05）;两组不良反应发生率差异无统计学意义（χ2=0.14,P〉0.05）.结论 氢吗啡酮用于瑞芬太尼复合麻醉术后镇痛,可有效预防RIH,减少术后其他镇痛药物的用量,且不增加不良反应.

Objective To explore the clinical effect of hydromorphone in the prevention of postoperative hyperpathia in patients receiving remifentanil combined anesthesia. Methods 64 patients who were scheduled to receive abdominal surgery and postoperative analgesia were randomly divided into hydromorphone group（ n = 32） and control group （ n = 32 ） according to random number table. All the cases were given PCIA after surgery, the control group was given fentanyl 12.5μg/kg,and the hydromorphone group was given fentanyl 12.5μg/kg ＋ hydromorphone 10μg/kg. The postoperative analgesic effects at different time, postoperative recovery, usage of PCIA and incidence of adverse effects in two groups were compared. Results There were no statistically significant differences in respiration recovery time,wake - up time,extubation time between the two groups （ t = 1.21,0.83,0.33, all P 〉 0.05 ）. The levels of MAP, HR after extubation of the hydromorphone group were significantly lower than those of the control group （ t = 2.84,2.66, all P 〈 0.05 ）. The VAS scores at 30 min, I h ,2h ,4h, 12h after operation in the hydromorphone group were significantly lower than those in the control group （t = 8.83,5.25,8.77,9.51,9.69, all P 〈 0.05 ） , while the difference was not statistically significant between the two groups at 24h after operation （ t = 1.87, P 〉 0.05 ）. The press times and dosage of fentanyl during 1 h, 24h after surgery of the hydromorphone group were significantly less than those of the control group （ t = 16.71,36.38,43.05,10.98, all P 〈 0.05 ）. The adverse reactions between the two groups had no statistically statistical difference （ χ2 = 0. 14, P 〉 0.05 ）. Conclusion Postoperative analgesia of remifentanil combined anesthesia with hydromorphone can effectively prevent RIH, reduce other anesthetics dose, and does not increase the risk of complications.