氢吗啡酮与地佐辛用于严重胸部创伤镇痛有效性、安全性及经济性比较

Comparison of Effectiveness,Safety and Economy of Hydromorphone and Dezocine for Analgesia in Patients with Severe Thoracic Trauma

目的比较氢吗啡酮与地佐辛用于严重胸部创伤镇痛治疗的有效性、安全性及经济性。方法选取医院重症医学科2021年4月至2022年9月收治的严重胸部创伤患者30例,根据镇痛方案的不同分为氢吗啡酮组和地佐辛组,各15例。两组患者分别予盐酸氢吗啡酮注射液和地佐辛注射液静脉泵入镇痛治疗,根据躁动情况予盐酸右美托咪定注射液镇静治疗,并根据患者呼吸情况、创伤情况等予对症治疗。结果两组患者镇痛后2,12,24 h的呼吸频率、氧合指数、二氧化碳分压及心率、平均动脉压比较,差异均无统计学意义(P>0.05)。与镇痛前比较,两组患者镇痛后2,12,24 h的呼吸频率显著降低,12,24 h的二氧化碳分压显著升高;地佐辛组患者镇痛后2 h的二氧化碳分压及镇痛后12,24 h的平均动脉压显著升高(P<0.05)。治疗后,两组患者均好转出院,且两组镇痛起效时间,重症监护室住院时间,气管插管发生率(镇痛后24 h内),恶心、呕吐发生率及谵妄发生率比较,差异均无统计学意义(P>0.05),也均未发生呼吸抑制。氢吗啡酮组患者的镇痛药物日均用量、日均费用、总费用均显著低于地佐辛组(P<0.05)。结论氢吗啡酮和地佐辛镇痛治疗严重胸部创伤患者均安全、有效,其中氢吗啡酮更具经济优势,而地佐辛可更快地缓解呼吸症状,且对循环系统影响更小。

Objective To compare the effecctiveness,safety and economy of hydromorphone and dezocine for analgesia in patients with severe thoracic trauma.Methods Thirty patients with severe thoracic trauma admitted to the Department of Critical Medicine at the hospital from April 2021 to September 2022 were selected and divided into the hydromorphone group and the dezocine group according to different analgesia plans,with 15 cases in each group.The two groups were treated with intravenous pumping of Hydromorphone Hydrochloride Injection and Dezocine Injection for analgesia respectively.All patients were treated with Dexmedetomidine Hydrochloride Injection for sedation based on restlessness and given symptomatic treatment based on the respiratory and trauma conditions.Results The respiratory rate(RR),oxygenation index(OI),partial pressure of carbon dioxide(PCO2),heart rate(HR)and mean arterial pressure(MAP)in the two groups at 2,12,24 h after analgesia were similar(P>0.05).Compared with those before analgesia,the RR was significantly lower at 2,12,24 h after analgesia,and PCO2 was significantly higher at 12,24 h after analgesia in the two groups;the PCO2 at 2 h after analgesia and MAP at 12,24 h after analgesia were significantly higher in the dezocine group(P<0.05).After treatment,both groups improved and discharged,and the analgesia onset time,stay days in intensive care unit,incidence of tracheal intubation(occurring within 24 h after analgesia),the incidence of nausea,vomiting and delirium in the two groups was similar(P>0.05),and no respiratory suppression occurred in the two groups.The daily average dosage,daily cost and total cost of analgesic drug in the hydromorphone group were significantly lower than those in the dezocine group(P<0.05).Conclusion Both hydromorphone and dezocine are safe and effective for analgesia in patients with severe thoracic trauma.Hydromorphone is more economical,but dezocine can relieve respiratory symptoms faster and has less effect on the circulatory system.