不同背景剂量氢吗啡酮对术后患者静脉自控镇痛效果的影响

Effect of Different Background Doses of Hydromorphone on Postoperative Intravenous Patient-controlled Analgesia

目的评估不同背景剂量下患者氢吗啡酮的镇痛效果、用药总量和不良反应。方法检索复旦大学附属中山医院厦门医院麻醉科术后镇痛记录系统,回顾性分析手术日期在2019年1月1日至2020年12月31日期间的术后镇痛记录。根据镇痛泵的不同背景剂量,分为低背景剂量组(LB组=0.025~0.04 mg/h,n=123)和高背景剂量组(HB=0.05~0.08 mg/h,n=107),比较两组患者术后24 h的患者自控镇痛总次数(patient controlled analgesia,PCA)、PCA有效次数、氢吗啡酮有效总量、静息和动态NRS疼痛评分和相关术后镇痛不良反应。结果高背景剂量组PCA总次数、PCA有效次数、氢吗啡酮有效总量和静息动态的NRS评分均比低背景剂量组低(P<0.05)。两组患者的术后不良反应事件发生率差异无统计学意义(P>0.05)。结论在单纯全身麻醉术后患者静脉自控镇痛中,较高背景剂量氢吗啡酮(0.05~0.08 mg/h)可提高镇痛效果,氢吗啡酮使用总量较少,阿片类相关不良反应相似。

Objective To evaluate the analgesic effect,total demand and adverse reactions of hydromorphone in patients with different background doses.Methods The medical records on postoperative pain management in our department from January 1,2019 to December 31,2020 were analyzed retrospectively.According to the different background dosage of analgesic pump,patients were allocated to two groups:low background dosage group(LB=0.025-0.04 mg/h,n=123)and high background dosage group(HB=0.05-0.08 mg/h,n=107).The total number of patient controlled analgesia(PCA),effective times of PCA,effective total consumption of hydromorphone,the score of Numeric Rating Scale(NRS)and adverse events associated with postoperative analgesic were compared between the two groups,respectively.Results The total number of patient controlled analgesia(PCA),effective times of PCA,effective total consumption of hydromorphone,the score of NRS in the high background dosage group were significantly lower than those in the low background dosage group(P<0.05).Adverse events associated with postoperative analgesic were no significantly between the two groups(P>0.05).Conclusion In patients with patient-control intravenous analgesia after general anesthesia,high background dosage group of hydromorphone(0.05-0.08 mg/h)can improve the analgesic effect,the total demand of hydromorphone was less,and the opioid-related side effects were similar.