氢吗啡酮复合氟比洛芬酯用于骨科术后镇静效果及对患者情绪的影响

The sedative effects and emotion influence of hydromorphone combined flurbiprofen axetil application used on postoperative PCIA in department of orthopedics

目的观察氢吗啡酮复合氟比洛芬酯用于骨科术后镇静效果及对患者情绪的影响。方法收集在腰硬联合麻醉下行骨科下肢手术的患者90例,随机分为3组,每组30例。术后镇痛泵配方SF组用舒芬太尼2~3μg/kg+托烷司琼10 mg,H组用氢吗啡酮0.12~0.14 mg/kg+托烷司琼10 mg,KH组用氢吗啡酮0.12 mg/kg+氟比洛芬酯50 mg+托烷司琼10 mg,分别记录各组患者一般状况、手术时间和术中用药量,术后2 h、6 h、12 h、24 h、48 h的Ramsay镇静评分,皮肤瘙痒、嗜睡、眩晕及消化道出血等不良反应发生情况,评估并比较2组术前与术后24 h患者情绪。结果 3组患者一般状况、手术时间以及麻醉药和血管活性药物的使用情况比较差异均无统计学意义(P均>0.05);各组患者术后2h、6 h、12 h、24 h、48 h的Ramsay镇静评分均<3分;3组患者均未发生消化道出血和皮肤瘙痒不良反应,KH组和H组发生眩晕情况明显少于SF组(P均<0.05);H组和KH组术后焦虑抑郁评分、心境量表评分均明显低于术前及SF组(P均<0.05)。结论氢吗啡酮复合氟比洛芬酯用于骨科下肢术后镇静效果好,不良反应少,对患者的情绪有明显改善作用。

Objective It is to observe the sedative effects and emotion influence of hydromorphone combined flurbiprofen axetil application used on postoperative patient control intravenous analgesia（PCIA） in department of orthopedics.Methods 90 patients who were undergoing combined spinal-epidural anesthesia for lower extremity surgery in department of orthopedics were enrolled,and were divided into 3 groups randomly,each group had 30 cases.SF group：sufentanil 2-3μg/kg＋tropisetron hydrochloride 10 mg;H group：hydromorphone 0.12-0.14 mg/kg＋tropisetron hydrochloride 10 mg;KH group：hydromorphone 0.12 mg/kg＋flurbiprofen axetil 50 mg＋tropisetron hydrochloride 10 mg,which were diluted with saline water to 100 mL.The general condition,operation time and dosage of each group were recorded;The Ramsay sedative score of patients in 3 groups were recorded at 2 h,6 h,12 h,24 h and 48 h after operation respectively;adverse effects such as pruritus,drowsiness,dizziness and digestive tract bleeding were observed;The emotion of these patients were assessed in the preoperative and postoperative 24 h.Results There was no statistical significance in general condition,operation time and anesthetics and vascular active drug dosage among the three groups（P0.05）;The ramsay scores of patients in 3 groups were all less than 3 points in 2 h,6 h,12 h,24 h and 48 h after operation（P0.05）;No side effect such as pruritus and digestive tract bleeding in the three groups;compared with group SF,the incidence of emergence dizziness was lower in groupH and KH（P0.05）;The scores of HAD and POMS were significantly lower than those before operation and in group SF（P0.05）.Conclusion The postoperative sedative effect of hydromorphone combined flurbiprofen axetil application used on postoperative PCIA of lower limbs operation are very good with less adverse reaction,they could obviously improve the patient＇s emotions.