盐酸氢吗啡酮用于骨科术后硬膜外自控镇痛的有效性研究

Study on effectiveness of hydromorphone hydrochloride on patient-controlled epidural analgesia after orthopedic surgery

目的研究盐酸氢吗啡酮在骨科术后硬膜外自控镇痛中的效果。方法130例接受骨科手术治疗的患者,应用随机抽签法分为研究组和对比组,每组65例。研究组患者在术后硬膜外自控镇痛中应用罗哌卡因及盐酸氢吗啡酮,对比组患者在术后硬膜外自控镇痛中仅应用罗哌卡因。比较两组患者镇痛前后疼痛介质水平,术后不同阶段(术后6、12、24、48 h)疼痛程度,镇痛效果,不良反应发生情况。结果镇痛后,两组患者P物质、前列腺素E2及β-内啡肽均明显低于本组镇痛前,且研究组P物质(70.65±10.24)pg/ml、前列腺素E2(165.25±12.67)pg/ml及β-内啡肽(72.49±7.65)pg/ml均明显低于对比组的(123.36±9.48)、(277.25±13.24)、(104.59±7.32)pg/ml,差异有统计学意义(P<0.05)。研究组患者术后6、12、24、48 h的视觉模拟评分法(VAS)评分分别为(2.96±1.10)、(2.70±0.46)、(2.32±0.25)、(1.68±0.25)分,均明显低于对比组的(4.66±2.62)、(4.33±0.25)、(4.21±0.33)、(3.15±0.31)分,差异有统计学意义(P<0.05)。研究组镇痛优良率96.92%明显高于对比组的84.62%,差异有统计学意义(P<0.05)。研究组不良反应发生率为1.54%,明显低于对比组的12.31%,差异有统计学意义(P<0.05)。结论在骨科术后硬膜外自控镇痛中采用盐酸氢吗啡酮镇痛能够有效促进镇痛效果的提升,可行性强,适合推广。

Objective To study the effect of hydromorphone hydrochloride on patient-controlled epidural analgesia after orthopedic surgery.Methods A total of 130 patients receiving orthopedic surgery were divided into research group and comparison group according to random lottery method,with 65 cases in each group.The research group received ropivacaine and hydromorphone hydrochloride in postoperative patient-controlled epidural analgesia,while the control group only received ropivacaine in postoperative patient-controlled epidural analgesia.Both groups were compared in terms of level of pain mediators before and after analgesia,pain level in different postoperative stages(6,12,24,48 h after surgery),analgesic effect,and occurrence of adverse reactions.Results After analgesia,the substance P,prostaglandin E2 andβ-endorphin in the two groups were significantly lower than those before analgesia in this group;the research group had substance P of(70.65±10.24)pg/ml,prostaglandin E2 of(165.25±12.67)pg/ml andβ-endorphin of(72.49±7.65)pg/ml,which were significantly lower than those of(123.36±9.48),(277.25±13.24)and(104.59±7.32)pg/ml in the control group;the differences were statistically significant(P<0.05).The visual analogue scale(VAS)scores at 6,12,24 and 48 h after surgery were(2.96±1.10),(2.70±0.46),(2.32±0.25)and(1.68±0.25)points,which were significantly lower than those of(4.66±2.62),(4.33±0.25),(4.21±0.33)and(3.15±0.31)points in the control group,and the differences were statistically significant(P<0.05).The excellent-good rate of analgesia in the research group was 96.92%,which was higher than that of 84.62%in the control group,and the difference was statistically significant(P<0.05).The incidence of adverse reactions in the research group was 1.54%,which was significantly lower than that of 12.31%in the control group,and the difference was statistically significant(P<0.05).Conclusion The application of hydromorphone hydrochloride in patient-controlled epidural analgesia after orthopedic surgery can effectively promote the improvement of analgesia effect,which is feasible and suitable for popularization.