氢吗啡酮与吗啡对胃肠手术患者的不同镇痛效果研究

Effects of hydromorphone and morphine on different analgesia in patients with undergoing gastrointestinal surgery

目的探究氢吗啡酮与吗啡对胃肠手术患者的不同镇痛疗效。方法回顾性选取2014年1月至2016年11月于接受胃肠手术的患者124例,按照镇痛方法不同分为4组,每组31例。其中A组患者首次给予2 mg吗啡和5 ml的0.125%罗哌卡因,维持为8 ml吗啡和100 ml的0.125%罗哌卡因;B组患者首次给予0.4 mg氢吗啡酮和5 ml的0.25%罗哌卡因,维持为1.6 mg氢吗啡酮和100 ml的0.125%罗哌卡因;C组患者首次给予2 mg吗啡和5 ml的生理盐水,维持为18 ml吗啡和100 ml生理盐水;D组患者给予0.4 mg氢吗啡酮和5 ml生理盐水,维持为3.6 mg氢吗啡酮和100 ml生理盐水,全部患者进行48 h镇痛,镇痛泵速度设定为2 ml/h。对各组患者的一般资料,镇痛前、镇痛6 h时、镇痛12 h时、镇痛24 h时和镇痛48 h时后的移动状态下疼痛评分(M-VAS)、静息状态下疼痛评分(R-VAS)、呼吸频率(RR)、心率(HR)、血氧饱和度(Sp O2)、舒张压(DBP)、收缩压(SBP)变化以及不良反应进行比较。结果 C组与患者头晕发生的概率较D组高,D组患者嗜睡症发生的概率较B组高,A组患者嗜睡症发生的概率较B组高,A组瘙痒症发生的概率比C组高,D组较ABC组低(P<0.05)。四组患者镇痛6 h时、镇痛12 h时、镇痛24 h时和镇痛48 h时后的SBP、DBP和Sp O2水平较镇痛前水平降低;HR、RR、R-VAS和M-VAS较镇痛前水平有所升高,差异具有统计学意义(P<0.05)。B组在镇痛6 h时、镇痛12 h时、镇痛24 h时和镇痛48 h时后SBP、DBP和Sp O2较A组低,HR、RR、RVAS和M-VAS较A组高,差异均有统计学意义(P<0.05);D组在镇痛6 h时、镇痛12 h时、镇痛24 h时和镇痛48 h时后SBP、DBP和Sp O2较C组低,HR、RR、R-VAS和M-VAS较C组高,差异均有统计学意义(P<0.05)。B组与D组数据比较,镇痛后24 h和镇痛后48 h DBP下降,差异具有统计学意义(P<0.05)。结论无论硬膜外应用还是静脉应用,氢吗啡酮的镇痛效果均优于吗啡,且可以更好地稳定血液流变学。

Objective To explore the different analgesic effects of hydromorphone and morphine in patients undergoing gastrointestinal surgery,and to improve the reference value. Methods 124 patients who underwent gastrointestinal surgery from January 2014 to November 2016 were randomly divided into 4 groups according to the random number table method. The patients were divided into epidural morphine group（ A）,epidural morphine group（ B）,intravenous morphine group（ C） and intravenous morphine group（ D） according to analgesia. Patients in group A received 2 mg of morphine and 5 ml of 0. 125% ropivacaine for the first time,maintained for 8 ml of morphine and 100 ml of 0. 125% ropivacaine;Group B received 0. 4 mg of hydromorphone and 5 ml 0. 25% ropivacaine for the first time By administration of 1. 6 mg of hydromorphone and 100 ml 0. 125% of ropivacaine; Group C patients were given 2 mg of morphine and 5 ml saline for the first time,maintained at 18 ml morphine and100 ml saline; Group D patients were given 0. 4 mg of hydromorphone and 5 ml saline,maintained at 3. 6 mg hydromorphone and 100 ml saline.All patients underwent 48 h analgesia and the analgesic pump speed was set at 2 ml/h. The changes of M-VAS,R-VAS,RR,HR,Sp O2,DBP,SBP in the postoperative analgesia and analgesia for 6 hours,12 hours of pain,24 hours of analgesia and 48 hours after analgesia Adverse reactions were compared. Results The probability of dizziness was higher in group C than in group D. The probability of narcolepsy in group D was higher than that in group B. The probability of narcolepsy in group A was higher than that in group B. The probability of occurrence of pruritus in group A was higher than that in group C. The D group was lower than the ABC group（ P〈0. 05）. The levels of SBP,DBP and Sp O2 in the four groups were lower than those in the ABCD group before analgesia and analgesia for 6 hours,RR,R-VAS and M-VAS were higher than those in the four groups before the analgesia（ P〈0. 05）. The SBP,DBP,and SpO_2 after 6 hours of analgesia,12 hours of analgesia,24 hours of analgesia,and 48 hours of analgesia of the patients in group B were lower than group A. The HR,RR,R-VAS,and M-VAS after 6 hours of analgesia,12 hours of analgesia,24 hours of analgesia,and 48 hours of analgesia of the patients in group B were higher than group A. The SBP,DBP,and SpO_2 after 6 hours of analgesia,12 hours of analgesia,24 hours of analgesia,and 48 hours of analgesia of the patients in group D were lower than group C. The HR,RR,R-VAS,and M-VAS after 6 hours of analgesia,12 hours of analgesia,24 hours of analgesia,and48 hours of analgesia of the patients in group D were higher than group C. Compared with D group,the DBP decreased at 24 h after analgesia and 48 h after analgesia（ P〈0. 05）. Conclusion The analgesic effect of morphine is better than that of morphine,whether it is epidural or intravenous. And can better stabilize blood rheology.