老年骨折患者术前疼痛敏感度与氢吗啡酮用药剂量的相关性分析

Correlation between preoperative pain sensitivity and dosage of hydromorphone in elderly patients with fracture

目的探讨老年骨折患者术前疼痛敏感度与氢吗啡酮用药剂量的相关性。方法选取我院2019年6月-2020年8月共收治的64例老年骨折患者作为研究对象,将患者随机分为观察组与对照组,每组32例,对照组患者手术结束前15分钟给予氢吗啡酮10μg/kg,观察组患者在手术结束前15分钟给予氢吗啡酮25μg/kg,对比两组患者不同时间的疼痛敏感度,对比两组患者不同时间的疼痛VAS评分,对比两组患者不同时间的心率、血压和去甲肾上腺素水平,并分析老年骨折患者疼痛敏感度与氢吗啡酮用药剂量的相关性。结果两组患者手术前耐痛阈和痛阈对比无显著差异(P>0.05),两组患者手术后6h和手术后12h的耐痛阈和痛阈明显高于手术前,且观察组高于对照组(P<0.05);两组患者手术前VAS评分对比无明显差异(P>0.05),术后6h VAS评分降低,术后12h VAS评分升高,且观察组患者在术后6h和术后12h的VAS评分明显低于对照组(P<0.05);两组患者手术前甲肾上腺素(NA)、血压(MAP)和心率(HR)对比无显著差异(P>0.05),手术中NA、MAP和HR明显上升,但组间对比无显著差异(P>0.05),到了手术后6h两组患者的NA、MAP和HR比手术中相比有所降低,且观察组低于对照组(P<0.05);Spearman相关分析结果显示:手术前耐痛阈、痛阈与氢吗啡酮用药剂量无明显相关性(P>0.05),手术后6h和手术后12h的耐痛阈、痛阈与氢吗啡酮用量呈正相关(P<0.05)。结论在手术结束前15分钟给予氢吗啡酮25μg/kg,患者术后疼痛感更低,耐痛阈和痛阈升高,并能够稳定患者甲肾上腺素、血压和心率情况,而且发现耐痛阈、痛阈与氢吗啡酮的用药剂量呈正相关,也可应用耐痛阈、痛阈水平来判断患者的麻醉镇痛,值得临床应用推广。

Objective To investigate the correlation between preoperative pain sensitivity and dosage of hydromorphone in elderly patients with fracture-Methods 64 cases of elderly fracture patients in our hospital from June 2019 to August 2020 were selected as the research objects,and they were randomly divided into the observation group and the control group,with 32 cases in each group.The control group was given hydromorphone 10μg/kg 15minutes before the end of operation,and the observation group was given hydromorphone 25μg/kg 15minutes before the end of operation,The VAS scores of pain,heart rate,blood pressure and norepinephrine levels of the two groups at different times were compared,and the correlation between pain sensitivity and dosage of hydromorphone in elderly patients with fracture was analyzed.Resu I ts There was no significant difference in the pain tolerance threshold and pain threshold between the two groups before operation(P>0.05),the pain tolerance threshold and pain threshold of the two groups at 6h and 12h after operation were significandy higher than those before operation,and the observation group was higher than that of the control group(P<0.05);there was no significant difference in the VAS score between the two groups before operation(P>0.05),the VAS score at 6h after operation decreased,and the VAS score at 12h after operation increased,and the patients in the observation group had no significant difference The VAS scores of the patients in the two groups were significandy lower than those in the control group at 6h and 12h after operation(P<0.05);there was no significant difference in norepinephrine(NA),blood pressure(map)and heart rate(HR)between the two groups before operation(P>0.05),while Na,map and HR increased significantly during operation,but there was no significant difference between the two groups(P>0.05),And the observation group was lower than the control group(P<0.05);Spcarman correlation analysis showed that there was no significant correlation between the pain tolerance threshold and the dosage of hydromorphone before operation(P>0.05),but there was a positive correlation between die pain tolerance threshold and the dosage of hydromorphone.6h and 12h after operation(P<0.05).Conelusion Hydromorphone 25μg/kg given 15 minutes before the end of operation can reduce the,postoperative pain,increase the pain tolerance threshold and pain threshold,stabilize the norepinephrine,blood pressure and heart rate of patients,and find that the pain tolerance threshold and pain threshold are positively correlated with the dosage of hydromorphone.It can also be used to judge the anesthesia and analgesia of patients,which is worthy of clinical application Wide.