氢吗啡酮在悬雍垂腭咽成形术患者术后镇痛中应用的有效性和安全性

Effects and Safety of Hydromorphone on Postoperative Analgesia in Patients Undergoing Uvulopalatopharyngoplasty

目的观察氢吗啡酮在悬雍垂腭咽成形术(uvulopalatopharyngoplasty,UPPP)患者术后静脉自控镇痛的应用效果。方法选择2018-01/2021-12月在作者医院行UPPP患者60例,采用随机数字表法将患者分为舒芬太尼组和氢吗啡酮组,每组各30例患者。舒芬太尼组术后静脉自控镇痛给予舒芬太尼2.0μg/kg+托烷司琼10 mg+0.9%生理盐水至100 ml,氢吗啡酮组术后静脉自控镇痛给予氢吗啡酮0.20 mg/kg+托烷司琼10 mg+0.9%生理盐水至100 ml。两组患者镇痛参数均为背景输注速率1.2 ml/h,患者自控镇痛(patient controlled analgesia,PCA)量2 ml,锁定时间10 min。记录两组患者术后2、6、12、24、48 h视觉模拟量表(visual analogue scale,VAS)评分,Ramsay镇静评分,术后48 h内有效按压次数、记录不良反应发生情况。结果舒芬太尼组术后6、24、48 h VAS评分明显高于氢吗啡酮组(P<0.05),术后12 h时VAS评分明显低于氢吗啡酮组(P<0.05),术后24 h Ramsay镇静评分明显高于氢吗啡酮组(P<0.05),氢吗啡酮组48 h内有效按压次数比舒芬太尼组明显减少(P<0.05)。舒芬太尼组恶心、呕吐、呼吸道梗阻发生率明显高于氢吗啡酮组(P均<0.05)。结论氢吗啡酮可以安全有效地用于UPPP患者术后PCA,0.20 mg/kg氢吗啡酮的镇痛效能优于2.0μg/kg舒芬太尼,且不良反应发生率低。

Objective To observe the effects of hydromorphone on postoperative intravenous self-control analgesia in patients undergoing uvulopalatopharyngoplasty(UPPP).Methods A total of 60 patients undergoing UPPP were selected from author′s hospital by random number table method from January 2018 to December 2021,and they were divided into sufentanil group and hydromorphone group,with 30 patients in each.Patients in sufentanil group received sufentanil 2.0μg/kg+tropisetron 10 mg+0.9% normal saline 100 ml for postoperative intravenous self-control analgesia,patients in hydromorphone group were given hydromorphone 0.20 mg/kg+tropisetron 10 mg+0.9% normal saline 100 ml for postoperative intravenous self-control analgesia.The analgesic parameters of the two groups were background infusion rate of 1.2 ml/h,the volume of patient controlled analgesia(PCA)was 2 ml,and the locking time was 10 min.Visual analogue scale(VAS),Ramsay sedation score at 2 h,6 h,12 h,24 h and 48 h after surgery and the number of effective compressions of patients within 48 h after surgery as well as the occurrence of adverse reactions were recorded.Results The VAS score of sufentanil was significantly higher than that in hydromorphone group at 6 h,24 h and 48 h after surgery(P<0.05),the VAS score at 12 h after surgery was significantly lower than that in hydromorphone group(P<0.05),the Ramsay sedation score at 24 h after surgery was significantly higher than that in hydromorphone group(P<0.05),and the number of effective compressions within 48 h of hydromorphone group significantly decreased than sufentanil group(P<0.05).The incidences of nausea,vomiting and airway obstruction in sufentanil group was significantly higher than those in hydromorphone group(all P<0.05).Conclusion Hydromorphone can be safely and effectively used for PCA after UPPP.The analgesic efficacy of 0.20 mg/kg hydromorphone is better than 2.0μg/kg sufentanil and the incidence of adverse reactions is low.