氢吗啡酮超前镇痛对妇科腔镜手术应激反应的影响  

Pre-emptive Analgesia Effects of Hydromorphone on Stress Reaction in Patients Undergoing Gynecological Laparoscopic Surgery

作　　者：张杨[1] 丁楠楠[2] 徐阳[1] 吴金晶[1] 

机构地区：[1]湖北医药学院附属襄阳医院麻醉科,襄阳441000 [2]湖北文理学院附属襄阳市中心医院药学部,襄阳441000

出　　处：《医药导报》2017年第4期417-419,共3页Herald of Medicine

摘　　要：目的观察氢吗啡酮超前镇痛对妇科腔镜手术应激反应的影响。方法择期全麻下行全子宫切除术患者40例,年龄45~58岁,ASA分级Ⅰ或Ⅱ级,体重指数18~24 kg·(m^2)^(-1),采用随机数字表法分为治疗组和对照组(n=20)。治疗组患者麻醉前静脉注射氢吗啡酮1 mg,两组患者常规诱导、插管,术中持续泵注瑞芬太尼0.2μg·min^(-1)·kg^(-1),异丙酚0.1 mg·min^(-1)·kg^(-1),间断推注顺式阿曲库铵,缝皮时停止泵注瑞芬太尼和丙泊酚。记录入手术室(t_1)、气腹前(t_2)、气腹后1 h(t_3)、患者清醒拔管时(t_4)血浆肾上腺素(E)和去甲肾上腺素(NE)的浓度,手术结束至拔管时间、拔管时患者心率、血压。结果两组患者手术后拔管时间无差异,治疗组苏醒期心率、收缩压低于对照组(P<0.05)。t_2、t_3、t_4时两组患者E值和NE值均高于t_1浓度(P<0.05),但3个时间段治疗组E值和NE值低于对照组(P<0.05)。结论氢吗啡酮超前镇痛能够减少妇科腔镜手术患者E和NE释放,不影响全麻苏醒时间,能够减小拔管时心率、血压上升幅度。Objective To investigate the pre-emptive analgesia effects of hydromorphone on stress reaction in patients undergoing gynecological laparoscopic surgery. Methods Forty ASA Ⅰ or Ⅱ patients [age ： 45 - 58 years, body mass index： 18 - 24 kg ·（ m^2）^-1 ] undergoing gynecological laparoscopic surgery were randomly divided into 2 groups （ n = 20 for each group） ： treatment group and control group. Hydromorphone （1 mg） was intravenously injected before anesthesia in treatment group. In the two groups, after routine induction and incubation, remifentanil （ 0. 2μg·min^-1·kg^-1, ） and propofol （0.1 mg·min^-1·kg^-1, ） were injected with micro perfusion pump, cisatracurium was injected intermittently. Injection of remifentanil and propofol was stopped when skin suture started. The concentrations of epinephrine（ E） and norepinephrine（ NE） were obtained before induction （ t2 ） , pneumoperitoneum （ t2 ） , 1 h after pneumoperitoneum （ t3 ） and extubation （ t4 ）, respectively. The heart rate, blood pressure and the time of operation to extubation of the patients were recorded. Results There were no significant changes in extubation time after operation among the groups. Heart rate and systolic blood pressure were significantly lower in the treatment group than in the control group （ P 〈 0. 05 ）. Plasma E and NE levels at t2 were significantly lower than those at t2 ,t3 and t4. Plasma E and NE were significantly lower in treatment group than that of control group at t2, t3 and t4 （ P 〈 0. 05 ） . Conclusion Pre-emptive analgesia of hydromorphone can significantly decrease the release of epinephrine and norepinephrine during and after laparoscopic surgery, restrain the increase of heart rate and systolic blood pressure during extubation, without influence of revival time.

关 键 词：氢吗啡酮 超前镇痛 应激反应 腹腔镜手术 

分 类 号：R971.2[医药卫生—药品] R969.3[医药卫生—药学]