摘要
目的 评价氢吗啡酮用于老年患者髋关节置换术后自控静脉镇痛的效果.方法 择期全麻下行单侧髋关节置换术老年患者70例,年龄65 ～ 75岁,体重40 ～ 70 kg,ASA分级Ⅰ或Ⅱ级.采用随机数字表法分为氢吗啡酮镇痛组（H组）和芬太尼镇痛组（F组）,每组35例.手术缝皮开始时,H组静脉注射负荷剂量氢吗啡酮20 μg/kg后连接自控静脉镇痛泵,药液为氢吗啡酮0.25 mg/kg＋托烷司琼10 mg＋120 ml生理盐水;F组于相同时点静脉注射负荷剂量芬太尼1μg/kg后连接自控静脉镇痛泵,药液为芬太尼25 μg/kg＋托烷司琼10 mg＋120 ml生理盐水中,2组镇痛泵背景输注速率均为2 ml/h,患者自控剂量为0.5 ml/次,锁定时间为15 min.静脉注射曲马多0.5 mg/kg进行补救镇痛,维持VAS评分≤3分.术后24和48 h时记录Ramsay评分、镇痛泵按压次数和曲马多给药次数,观察术后48 h内不良反应的发生情况,记录镇痛总体满意度.结果 H组和F组患者Ramsay评分、镇痛泵按压次数和曲马多给药次数比较差异无统计学意义（P＞0.05）;与F组比较,H组术后恶心呕吐、呼吸抑制、嗜睡、尿潴留等不良反应发生率降低,镇痛总体满意度升高（P＜0.05）.结论 氢吗啡酮用于老年患者髋关节置换术后自控静脉镇痛效果确切,不良反应少,患者满意度高.
Objective To evaluate the efficacy of hydromorphone for patient-controlled intravenous analgesia （PCIA） after hip replacement in elderly patients.Methods Seventy patients, aged 65-75 yr, weighing 40-70 kg, of American Society of Anesthesiologists physical status Ⅰ or Ⅱ , undergoing elective unilateral hip replacement, were randomly divided into either analgesia with hydromorphone group （group H, n =35） or analgesia with fentanyl group （group F, n=35）.After a loading dose of 20 μg/kg of hydromorphone was injected at the beginning of skin closure, a PCA pump was connected, and the PCIA solution contained hydromorphone 0.25 mg/kg and tropisetron 10 mg in 120 ml of normal saline in group H.After a loading dose of 1 μg/kg of hydromorphone was injected at the beginning of skin closure, a PCA pump was connected, and the PCIA solution contained fentanyl 25 μg/kg and tropisetron 10 mg in 120 ml of normal saline in group F.The PCA pump was set up with a 0.5 ml bolus dose, a 15 min lockout interval and the background infusion at a rate of 2 ml/h in both groups.Tramadol 0.5 mg/kg was injects intravenously as rescue analgesic, and visual analogue scale score was maintained ≤ 3.The Ramsay sedation score,the number of attempts and the number of tramadol administration were recorded at 24 and 48 h after operation.The adverse effects within 48 h after operation and patient＆#39;s satisfaction with analgesia were recorded.Results There was no significant difference in the Ramsay sedation score, the number of attempts and the number of Tramadol administration between H and F groups.Compared with group F, the incidence of adverse effects such as postoperative nausea, vomiting, respiratory depression, drowsiness, urinary retention, was significantly decreased, and the level of satisfaction with analgesia was increased in group H.Conclusion Hydromorphone provides accurate efficacy for PCIA after hip replacement in elderly patients, with fewer adverse effects and higher level of patient＆#39; s satisfaction.
出处
《中华麻醉学杂志》
CAS
CSCD
北大核心
2015年第8期963-965,共3页
Chinese Journal of Anesthesiology
基金
四川省卫生厅科研课题基金（110361）
关键词
氢吗啡酮
镇痛
病人控制
老年人
关节成形术
置换
髋
Hydromorphone
Analgesia,patient-controlled
Aged
Arthroplasty,replacement,hip
