氢吗啡酮用药剂量对老年患者骨科术后自控静脉镇痛效果的影响研究

Effects of Hydromorphone Dosage on Patient-controlled Intravenous Analgesia in Elderly Patients after Orthopaedic Surgery

目的探讨氢吗啡酮不同用药剂量对老年患者骨科术后自控静脉镇痛(PCIA)效果的影响。方法随机数表法将本院2016年1月至2019年1月诊治的144例老年骨科手术患者分为A、B、C和对照组四组,各36例,A、B、C组氢吗啡酮用药剂量分别为10μg/kg、25μg/kg和40μg/kg,对照组用药剂量为1μg/kg芬太尼。采用视觉模拟评分法(VAS)和Ramsay镇静评分测定术后1h、2h、4h、12h、24h、48h的疼痛评分和镇静评分。结果A、B、C三组镇痛效果普遍比对照组效果好,刚开始用药时,A、B、C三组镇痛效果差距不大,在用药4h后B组和C组镇痛效果要比A组好,B组和C组效果相当,随时间增长,B组镇痛效果高于C组且不良反应较少。结论25μg/kg剂量的氢吗啡酮用于老年骨科手术患者术后自控静脉镇痛效果更好,不良反应更少,是合适的临床用量。

Objective To explore the effects of different dosages of hydromorphone on patient-controlled intravenous analgesia in elderly patients afterorthopaedic surgery.Methods A random number table method was used to divide 144 elderly patients with orthopedic surgery who were treated in the hospital from January 2016 to January 2019 into four groups,including groups A,B and C and control group,36 cases in each group.Groups A,B and C were given hydromorphone at dosages of 10μg/kg,25μg/kg and 40μg/kgrespectively,andcontrol group was given 1μg/kg fentanyl.Pain score and sedation score at 1 h,2 h,4 h,12 h,24 h and 48 h after surgerywere measured by pain visual analogue scale(VAS)and Ramsay sedation score.Results The analgesic effects in groups A,B and C were generally better than those in control group.At the beginning of treatment,the analgesic effects in groups A,B and C were not much different.And the analgesic effects in group B and group C after 4 h of treatment were better than those in group A,and the effects in group B and group C were the same.With the increase of time,the analgesic effects in group B were higher than those in group C,and the adverse reactions were less.Conclusion Hydromorphone at a dosage of 25μg/kg has better effects of postoperative patient-controlled intravenous analgesia(PCIA)and fewer adverse reactionsin elderly patients with orthopedic surgery,and it is a suitable clinical dosage.