氢吗啡酮混合罗哌卡因PCEA用于肾移植术后镇痛的效果

Systemic evaluation of efficacy and safety of hydromorphone combined with ropivacaine on PCEA after renal transplantation

目的评价盐酸氢吗啡酮混合罗哌卡因硬膜外自控镇痛(PCEA)对肾移植术后患者的镇痛效果及安全性。方法拟行同种异体肾移植患者60例,年龄25~60岁,体重51~84 kg,ASAⅡ~Ⅲ级,随机分为两组(n=30):吗啡混合罗哌卡因PCEA组(M组)和氢吗啡酮混合罗哌卡因PCEA组(H组)。术毕行PCEA,M组药物:吗啡40μg/mL+罗哌卡因1 mg/mL;H组:氢吗啡酮4μg/mL+罗哌卡因1 mg/mL。参数设置:负荷剂量5 mL,背景输注速率5 mL/h,PCEA剂量0.5 mL,锁定时间15 min。于术后4、12、24、48 h时记录VAS评分、Ramsay评分。记录术后48 h内PCEA有效按压次数和镇痛补救情况,计算镇痛补救率,评价镇痛满意度。记录术后48 h内恶心呕吐、皮肤瘙痒、呼吸抑制和导尿管相关膀胱刺激征等不良反应的发生情况。麻醉前、术后24、48、72 h采集静脉血,检测血清肌酐(Cr)、尿素氮(BUN);采集尿液,检测胱抑素C(CysC)、β2-微球蛋白(β2-MG),同时记录尿量。结果与M组比较,H组在术后4、12 h时点R-VAS、M-VAS评分明显降低(P<0.05);与M组相比,H组术后各时点BUN、Cr、CysC、β2-MG浓度明显降低,尿量明显增加(P<0.05),H组患者术后48 h内镇痛补救率、PCEA有效按压次数明显减少、镇痛满意度明显增高、恶心呕吐、皮肤瘙痒发生率明显降低(P<0.05)。结论氢吗啡酮混合罗哌卡因PCEA用于同种异体肾移植术后镇痛效果确切,不良反应发生率低,且有助于移植肾功能的恢复。

Objective To evaluate the analgesic efficacy and safety of hydromorphone hydrochloride combined with ropivacaine for epidural controlled analgesia(PCEA)after renal transplantation.Methods Sixty allograft renal transplantation patients(ASAⅡorⅢ),Age 25-60,Weight 51-84 kg,were randomly divided into 2 groups(n=30):Morphine mixed with ropivacaine PCEA group(Group M)and hydromorphone mixed with ropivacaine PCEA group(Group H).PCEA were used by all patients as follows.Group M:Morphine 40μg/mL+ropivacaine 1 mg/mL;Group H:hydromorphone 4μg/mL+ropivacaine 1 mg/mL.Parameters:loading dosage 5 mL,Infusion speed 5 mL/h;PCEA dosage 0.5 mL each time;monitor time:15 mins.At 4,12,24 and 48 h after operation,VAS and Ramsay score were recorded.During this period,times of effective pressing of PCEA and the remedial analgesia situation were documented and used to calculate the analgesic remedy frequency.Patient satisfaction with analgesia was also recorded.At 48 h after operation,the incidence of adverse reactions,such as nausea,vomiting,pruritus respiratory depression,and bladder irritation were recorded.Before anesthesia or at the time of 24,48,72 h after operation,the levels of urea nitrogen(BUN)and creatinine(Cr)were determined,and urine volume,urine Cysc、β2-MG were recorded.Results Compared with Group M,at 4,12 h after operation R-VAS score,M-score were greatly decreased in the H group(P<0.05);24 h,48 h,72 h after transplantation,Cr,BUN,urine Cysc、β2-MG decreased and the urine output increased compared with M group(P<0.05).At 48 h after operation analgesic remedy frequency,times of effective pressing time of PCEA,incidence of nausea,vomiting,pruritus,respiratory depression,and bladder irritation were reduced,and patient satisfaction with analgesia were increased in the H group(P<0.05).Conclusion Hydromorphone combined with ropivacaine for PCEA after transplantation had better analgesic effect with lower incidence of adverse reactions,which may facilitate the recovery of renal graft function.