1. 中山大学附属第一医院,广东,广州,510080
2. 兰州大学第二医院,甘肃,兰州,730030
网络首发:2017-05-06,
纸质出版:2017
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王益敏, 林世清, 孙来保, 等. 氢吗啡酮术后镇痛对肠道腔镜手术患者苏醒期CO 2 残留的影响[J]. 中山大学学报(医学科学版), 2017,38(3).
Effect of Hydromorphone for Postoperative Analgesia on Residual Carbon Dioxide during Recovery after Laparoscopic Colorectal Surgery[J]. Journal of Sun Yat-sen University (Medical Sciences), 2017, 38(3).
【目的】探讨氢吗啡酮用于术后镇痛对肠道腔镜手术患者苏醒期CO 2 残留的影响。【方法】100例全麻下行腹腔 镜结直肠手术患者随机均分为2组,术后均行静脉自控镇痛,镇痛配方为氢吗啡酮8 mg(H组),吗啡40 mg(M组),分别用生 理盐水稀释至100 mL,单次按压剂量2 mL/次,背景剂量2 mL/h,锁定时间15 min,2组均于手术结束前半小时开启静脉镇痛 泵。记录手术、气腹、麻醉、拔管、苏醒及在麻醉恢复室停留时间,气腹后30 min(T 0 )拔管后10 min(T 1 )、拔管后30 min(T 2 )、 1 h(T 3 )、2 h(T 4 )及24 h(T 5 )的PaCO 2 、VAS疼痛评分、Ramsay镇静评分、术后肩背部疼痛、恶心、呕吐、嗜睡、皮肤瘙痒等不良 反应情况以及术后患者满意度。【结果】与H组比较,M组T 2 ~ T 4 时PaCO 2 升高,术后苏醒时间,拔管时间及恢复室停留时间 均延长,肩背部疼痛,恶心、呕吐,嗜睡发生率均高于H组(P < 0.05)。与M组比较,H组T 1 ~ T 3 时VAS评分降低(P < 0.05), 在T1 ~ T4时Ramsay镇静评分降低(P < 0.05)。【结论】与吗啡相比较,氢吗啡酮用于腹腔镜肠道手术术后镇痛效果好,不良 反应少,可降低患者苏醒期的CO 2 残留,是一种安全有效的术后镇痛药物。
【Objective】To evaluate the effect of hydromorphone for postoperative analgesia on residual carbon dioxide during recovery after laparoscopic colorectal surgery.【Methods】A total of 100 patients performed with elective laparoscopic colorectal sur? gery were randomly allocated into two groups according to different patient controlled intravenous analgesia(PCIA)formula:Group H contained hydromorphone 8 mg and Group M contained morphine 40 mg. Total PCIA volume was 100 mL saline with loading volume 2 mL,background volume 2 mL/h,and lockout time was set on 15 min. Analgesia infusion pump was used in the two groups half an hour before the end of surgery. Surgery time,pneumoperitoneum time,anesthesia time,extubation time,recovery time and retention time in postanesthesia care unit(PACU)were recorded,respectively. PaCO 2 ,the pain Visual Analogue Scale(VAS)score,Ramsay sedation score,at 30 min(T0)after pneumoperitoneum,extubation time(T 1 ),30 min(T 2 ),1 h(T 3 ),2 h(T 4 ),and 24 h(T 5 )af? ter extubation,the times of PCA compressions were recorded. Anesthesia complications during waking-up period such as postopera? tive nausea and vomiting(PONV),shoulder pain,hypersomnia,pruritus and satisfaction degree after surgery were also recorded. 【Results】Compared with group H,PaCO 2 was higher at T 2 ~ T 4 (P < 0.05);Recovery time,extubation time and the retention time in PACU were longer after surgery(P < 0.05);The incidence of postoperative nausea and vomiting,shoulder pain were higher in group M(P < 0.05). Compared with group M,VAS score at T 1 ~ T 3 ,and Ramsay sedation score T 1 ~ T 4 were decreased in group H(P < 0.05).【Conclusion】Compared with morphine,hydromorphone can increase fewer residual carbon dioxide during recovery and fewer side effects for the patients caused by that after laparoscopic colorectal surgery. Hydromorphone was a safer and more effective analgesic for postoperative analgesia than morphine.
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