盐酸氢吗啡酮联合罗哌卡因用于骨科术后自控硬膜外镇痛的效果

Hydromorphone Hydrochloride Combined with Ropivacaine for Patient-Controlled Epidural Analgesia after Orthopedic Surgery

目的探讨骨科术后采用盐酸氢吗啡酮联合罗哌卡因自控硬膜外镇痛(PCEA)的临床效果。方法将行骨折手术治疗的94例患者按抽签法随机分为2组:对照组47例术后采用罗哌卡因+盐酸吗啡PCEA,研究组47例术后采用罗哌卡因+盐酸氢吗啡酮PCEA。比较2组镇痛前后疼痛介质与氧化应激指标水平的变化情况,观察2组PCEA期间不良反应发生情况。疼痛介质包括一氧化氮(NO)、前列腺素E2(PGE2)与5-羟色胺(5-HT)等,氧化应激指标包括丙二醛(MDA)、谷胱甘肽过氧化物酶(GSH-Px)等,不良反应包括皮痒、恶心呕吐、头晕等。结果2组镇痛后NO、PGE2、5-HT、MDA水平均较镇痛前显著降低,GSH-Px水平较镇痛前显著升高(P<0.05),且研究组改善情况明显优于对照组(P<0.05);2组PCEA期间不良反应发生率比较差异无统计学意义(P>0.05)。结论盐酸氢吗啡酮联合罗哌卡因用于骨科术后PCEA可减轻氧化应激反应,抑制疼痛介质释放,且不良反应少,安全性较高。

Objective To explore the efficacy of patient-controlled epidural analgesia(PCEA) with hydromorphone hydrochloride and ropivacaine after orthopedic surgery. Methods A total of 94 patients who underwent surgery for fractures were randomly given ropivacaine combined with either morphine hydrochloride(control group, n =47) or hydromorphone hydrochloride(study group, n =47) for postoperative PCEA.Pain mediators nitric oxide(NO),prostaglandin E2(PGE2) and 5-hydroxytryptamine(5-HT) and oxidative stress indicators malondialdehyde(MDA) and glutathione peroxidase(GSH-Px) were measured before and after PCEA.The incidence of adverse reactions(itching,vomiting,dizziness,etc.) was compared between the two groups. Results The levels of NO,PGE2,5-HT and MDA decreased and GSH-Px levels increased in both groups after PCEA,and the improvement in study group was more obvious than that in control group( P < 0.05).There was no significant difference in the incidence of adverse reactions between the two groups( P >0.05). Conclusion Hydromorphone hydrochloride combined with ropivacaine for PCEA after orthopedic surgery can alleviate oxidative stress and inhibit pain mediator release with few adverse reactions and high safety.