不同剂量氢吗啡酮患者自控镇痛用于面肌痉挛微血管减压术后镇痛疗效的比较

Efficacy of different bolus hydromorphone as patient-controlled intravenous analgesia for facial spasm after microvascular decompression

目的观察氢吗啡酮患者自控静脉镇痛(patient-controlled intravenous analgesia,PCIA)用于面肌痉挛颅内显微血管减压术后镇痛的疗效。方法选择77例美国麻醉医师协会分级Ⅰ~Ⅱ级择期面肌痉挛手术患者,心、肺、肝、肾、凝血功能未见异常,接受颅内显微血管减压术治疗,无镇痛药物滥用史。术中采用全静脉麻醉,术后将患者随机分组接受PCIA治疗。PCIA参数与分组:托烷司琼10 mg与氢吗啡酮10 mg溶于生理盐水共100 mL,PCIA参数为背景剂量0.1 mL/h、锁定时间5 min、极限量10 mL/h,按照单次量不同将患者按照随机数字表分为A、B 2组。A组单次剂量1 mL、B组单次剂量2 mL;观察患者术后24、48 h头痛、切口疼痛在静息、活动以及咳嗽时的视觉模拟评分、患者满意度、术后恶心呕吐(postoperative nausea and vomiting,PONV)、皮肤瘙痒、过度镇静等指标。结果与A组比较,B组术后24 h切口活动性疼痛减轻(P=0.048),其余疼痛2组比较差异无统计学意义(P>0.05)。2组PONV、患者满意度、皮肤瘙痒等比较差异无统计学意义(P>0.05)。多因素线性回归表明PONV与性别、晕动病史/既往PONV史有关。结论较大单次量氢吗啡酮镇痛作用更强且不增加术后恶心程度与呕吐次数,晕动病史/既往PONV史与性别是颅内显微血管减压术后PONV的主要危险因素之一。

Objective To investigate the efficacy of different bolus of hydromorphone on postoperative pain and postoperative nausea and vomiting(PONV) after microvascular decompression for facial spasm.Methods We enrolled 77 patients who underwent microvascular decompression,American Society of Anesthesiologists(ASA) physical statues were Ⅰ-Ⅱ level.Exclusion criteria included:a history of mental disease,active liver disease,cardiac dysfunction,pulmonary dysfunction and renal dysfunction.Propofol and sufentanil were used for anesthesia induction and propofol and remifentanil were used for the maintenance of anesthesia.Intervenous analgesia was used during the operation.Patients were randomly assigned to two groups,group A and group B.Hydromorphone 10 mg and tropisetron 10 mg were mixed and diluted to 100 mL.The patient-controlled intravenous analgesia(PCIA) parameters were included,base rate 0.1 mL/h,lock time 5 minutes,bolus 1 mL in group A and bolus 2 mL in group B,limited 10 mL per hour.Headache,incision pain at rest,activity and cough,patient satisfaction scores,PONV,inch of skin and sedation were recorded at 24 h and 48 h after surgery.Results Compared with group A,the incision pain at activity was alleviated at 24 h after surgery in group B(P = 0.048).There were no significant differences in patient satisfaction,itch of skin and PONV between two groups.Multiple linear regression showed that PONV was related to gender,motion sickness and previous PONV history.Conclusion This study demonstrated higher bolus of hydromorphone was better than lower bolus to control pain at activity.However,higher bolus of hydromorphone did not worsen PONV.Motion sickness was one of the major risk factors of PONV.