氢吗啡酮静脉自控镇痛对瘢痕妊娠患者辅助行子宫动脉栓塞术后镇痛的有效性和安全性

The efficacy and safety of hydromorphone patients-controlled intravenous analgesia in patients with scar pregnancy after uterine artery embolization

目的评价氢吗啡酮静脉自控镇痛(pcatient-controlled intravenous analgesia,PCIA)对瘢痕妊娠患者辅助行子宫动脉栓塞术(uterine artery embolization,UAE)术后镇痛的有效性和安全性。方法 选取2021年1月至2022年9月在阜阳市人民医院瘢痕妊娠行UAE辅助治疗的患者116例。依据UAE术后PCIA药物不同,随机分为观察组、对照组,每组为58例。分别于手术开始前10 min静注氢吗啡酮2 mg(观察组)和舒芬太尼2μg/kg(对照组),并连接患者自控静脉镇痛泵。观察组:氢吗啡酮10 mg+氟比洛芬酯100 mg+0.9%氯化钠注射液100 mL配置至镇痛泵中;对照组:舒芬太尼2μg/kg+氟比洛芬酯100 mg+0.9%氯化钠注射液100 mL配置至镇痛泵中。记录两组患者UAE术后0.5、4、8、12、24、48 h视觉模拟量表(visual analogue scale,VAS)评分、布鲁格曼舒适度量表(Bruggrmann comfort scale,BCS)评分,术后48 h内镇痛泵按压次数、镇痛药物用量、不良反应及术后并发症发生率。结果 观察组术后0.5 h VAS评分与对照组比较,差异无统计学意义(P>0.05),而术后4、8、12、24、48 h VAS评分明显低于对照组,差异有统计学意义(均P<0.05)。观察组术后0.5、4、8、12、24、48 h BCS评分明显高于对照组,差异有统计学意义(P<0.05)。观察组术后48 h内镇痛泵按压次数、镇痛药物用量低于对照组,差异有统计学意义(均P<0.05)。两组患者嗜睡、皮肤瘙痒、低氧或呼吸抑制等并发症比较差异无统计学差异(P>0.05),而两组患者不良反应发生率比较差异有统计学差异(P<0.05)。结论 氢吗啡酮和舒芬太尼PCIA有助于缓解瘢痕妊娠子宫动脉栓塞术术后疼痛,但氢吗啡酮对比舒芬太尼可明显降低术后VAS评分、提高术后BCS评分,术后48 h内镇痛泵按压次数及镇痛药物用量减少、不良反应发生率较低,有一定的推广价值。

Objective To evaluate the postoperative analgesia efficacy and clinical safety of hydromorphone patients-controlled intravenous analgesia(PCIA) in patients with scar pregnancy after auxiliary uterine artery embolization(UAE). Methods A total of 116 patients with scar pregnancy, who received auxiliary UAE at the Fuyang Municipal People's Hospital of China between January 2021 and September 2022, were enrolled in this study. According to the intravenous self-controlled analgesic drugs used after UAE, the patients were randomly and equally divided into observation group(n=58) and control group(n=58). Ten minutes before the procedure, intravenous injection of 2 mg hydromorphone(observation group) or 2 μg/kg sufentanyl(control group) was performed, and the PCIA pump was connected. In the observation group, the mixed solution of 10 mg hydromorphone + 100 mg flurbiprofen axetil + 100 mL saline was put in the analgesic pump, while in the control group, the mixed solution of 2 μg/kg sufentanyl + flurbiprofen axetil 100 mg + 100 mL saline was put in the analgesic pump. The post-UAE 0.5-h, 4-h, 8-h, 12-h, 24-h and 48-h visual analogue scale(VAS) scores,the Bruggrmann comfort scale(BCS) scores, the number of pressing analgesic pump times within postoperative48 hours, the used dosage of analgesic drugs, the adverse reactions, and the incidence of postoperative complications were recorded. Results The difference in the post-UAE 0.5-h VAS scores between the observation group and the control group was not statistically significant(P>0.05), while the post-UAE 4-h, 8-h, 12-h, 24-h and 48-h VAS scores in the observation group were significantly lower than those in the control group, and the differences were statistically significant(all P<0.05). The post-UAE 0.5-h, 4-h, 8-h, 12-h, 24-h and 48-h BCS scores in the observation group were significantly higher than those in the control group, and the differences were statistically significant(all P<0.05). The number of pressing analgesic pump times and the used dosage of analgesic drugs within postoperative 48 hours in the observation group were lower than those in the control group, and the differences were statistically significant(all P <0.05). No statistically significant differences in the complications such as drowsiness, skin itching, hypoxia, or respiratory depression, etc. existed between the two groups, while the difference in the incidence of adverse reactions between the two groups was statistically significant(P<0.05). Conclusion Hydromorphone and sufentanil PCIA can relieve the pain in scar pregnancy patients after UAE. Hydromorphone is superior to sufentanil in reducing the number of pressing analgesic pump times within postoperative 48 hours, reducing the used dosage of analgesic drugs, and decreasing the incidence of adverse reactions, therefore, hydromorphone PCIA has a certain promotion value.