氢吗啡酮在骨科术后多模式镇痛中的临床观察

Clinical Observation of Hydromorphine Ketone in Multimode Analgesia After Orthopaedic Surgery

目的观察氢吗啡酮在骨科术后多模式镇痛中的有效性及安全性。方法选取我院骨科手术患者100例随机分为HM组(观察组50例):盐酸氢吗啡酮0.1 mg/kg,右美托咪定2μg/kg,帕洛诺司琼0.5 mg,生理盐水加至100 ml;SF组(对照组50例):舒芬太尼2μg/kg,右美托咪定2μg/kg,帕洛诺司琼0.5 mg,生理盐水加至100 ml。所有受试对象均采用一次性自控镇痛泵,背景输注剂量为2 ml/h,单次冲击剂量0.5 ml,锁定时间15 min。手术结束前30 min, HM组经硬膜外导管注入氢吗啡酮镇痛液10 ml(含氢吗啡酮0.5 mg的0.15%布比卡因溶液10 ml),SF组经硬膜外导管注入舒芬太尼镇痛液10 ml(含舒芬太尼20μg的0.15%布比卡因溶液10 ml)。结果比较两组术后36 h PCA有效按压次数和VAS评分、Ramsay镇静评分、术后镇痛不良反应发生率、术后认知功能、患者满意度等方面,差异无统计学意义(P>0.05),HM组表现情绪改善倾向(P<0.05)。结论氢吗啡酮可安全有效地用于骨科术后多模式镇痛,镇痛效果好,患者情绪更稳定,舒适度更高,有利于患者术后康复。

Objective To observe the efficacy and safety of hydromorphine in multi-mode analgesia after orthopedic surgery.Methods 100 patients undergoing orthopedic surgery in our hospital were randomly divided into HM group(Observation group,n=50):HM group(observation group,n=50):hydromorphine 0.1 mg/kg,right metomidine 2μg/kg,parenoxetron 0.5 mg,saline to 100 ml;SF group(control group,n=50),sufentanil 2μg/kg,right metomipramine 2μg/kg,parenoxetron 0.5 mg,saline to 100 ml.All subjects were treated with a single-time self-controlled analgesia pump,with a background infusion dose of 2 ml/h,a single impact dose of 0.5 ml,a locking time of 15 min.30 min before surgery,HM group was injected with hydromorphine analgesic solution 10 ml(0.15%bupivacaine solution containing 0.5 mg of hydromorphine 10 ml)via epidural catheter and sf group with sufentanil analgesic solution 10 ml(0.15%bupivacaine solution containing 20μg of sufentanil 10 ml).Results There was no significant difference in the number PCA effective compression and VAS scores,Ramsay sedation scores,incidence of postoperative analgesic adverse reactions,postoperative cognitive function,patient satisfaction and so on between the two groups(P>0.05),and the HM group showed a tendency to improve mood(P<0.05).Conclusion Hydromorphine can be safely and effectively used for multi-mode analgesia after orthopedic surgery,the analgesic effect is good,the patient’s mood is more stable and the comfort is higher,which is beneficial to the patient’s postoperative recovery.