氢吗啡酮与舒芬太尼复合布比卡因蛛网膜下腔阻滞麻醉的镇痛效果对比

Comparison of the effects of intrathecal hydromorphone or sufentanil as adjuvants to bupivacaine in subarachnoid anesthesia

目的:比较盐酸氢吗啡酮与枸橼酸舒芬太尼复合布比卡因对肛肠手术的术后镇痛效果。方法:ASAⅠ级~Ⅱ级择期行肛肠外科手术的患者60例,随机分为两组:舒芬太尼组(S组)和氢吗啡酮组(H组)。蛛网膜下腔注药后评估镇痛和运动阻滞起效及持续时间。记录头晕、恶心、呕吐、瘙痒、寒颤,尿潴留,呼吸抑制等不良反应。结果:H组患者注药后6 h、8 h、10 h、12 h、16 h、20 h VAS评分≥4分所占比例明显较S组少,差异有统计学意义(P<0.05)。两组患者蛛网膜下腔注药后双下肢运动达Bromage1级时间S组(18.03±11.01 min)与H组(16.63±6.87 min)比较,差异无统计学意义(P>0.05),但蛛网膜下腔注药后到双下肢恢复至Bromage0级的时间H组(266.13±96.15 min)比S组(202.17±102.46 min)时间长,差异有统计学意义(P<0.05)。H组头晕、恶心、呕吐、皮肤瘙痒、尿潴留等不良反应发生率比S组高,差异有统计学意义(P<0.05)。结论:盐酸氢吗啡酮100μg复合布比卡因可安全的用于蛛网膜下腔镇痛,虽然不良反应发生率较舒芬太尼10μg复合布比卡因多,但镇痛时间较舒芬太尼长。

Objective To compare the analgesia efficacy of subarachnoid injection hydromorphone or sufentanil as adjuvants to bupivacaine in patients undergoing anorectal operation.Method Sixty patients undergoing anorectal operation were randomly assigned into two groups with 30 cases each hydromorphone group(Group H),sufentanil group(Group S).The onset and duration of analgesia and motor block were assessed after subarachnoid administration of the drugs.The incidence of adverse events such as dizziness,nausea,vomiting,pruritus,shivering and urinary retention,respiratory depression was recorded.Results The proportion of VAS score(≥4)in group H at 6,8,10,12,16 and 20 hours after subarachnoid injection was significantly lower than that in group S(P<0.05).There was no significant difference between group S(18.03±11.01 min)and group H(16.63±6.87 min)in the time of reaching Bromage level 1 after subarachnoid injection(P>0.05).The time from subarachnoid injection to recovery of lower limbs to Bromage 0 was longer in group H(266.13±96.15 min)than in group S(202.17±102.46 min)(P<0.05).There was significant difference in the incidence of adverse events such as nausea,vomiting,dizziness,pruritus and urinary retention was higher in group H than that in the group S(P<0.05).Conclusion Hydromorphone 100μg combined with bupivacaine can be safely used for subarachnoid analgesia.Although the incidence of adverse events is higher than sufentanil 10μg combined with bupivacaine,The duration of postoperative analgesia with subarachnoid injection hydromorphone 100μg as adjuvant to bupivacaine is longer than that of sufentanil 10μg.