64例膝关节镜术后关节腔内注射不同剂量盐酸氢吗啡酮的镇痛效果研究  

Study on the analgesic effect of intra-articular injection of hydrochlormorphone hydrochloride on 64 patients after arthroscopic knee surgery

作　　者：周昶 吴荭[1] 张丁[1] 陶清[1] 陈庆一[1] ZHOU Chang;WU Hong;ZHANG Ding;TAO Qing;CHEN Qing-yi(Department of Anesthesiology,The First Affiliated Hospital of Anhui University of Traditional Chinese Medicine,Hefei 230031,Anhui,China)

机构地区：[1]安徽中医药大学第一附属医院麻醉科,安徽合肥230031

出　　处：《川北医学院学报》2018年第4期554-556,560,共4页Journal of North Sichuan Medical College

基　　金：安徽省高等学校省级自然科学研究项目(KJ2012Z215)

摘　　要：目的:探讨膝关节镜术后关节腔内注射不同剂量盐酸氢吗啡酮对患者术后镇痛效果。方法:选取行膝关节镜手术患者64例,手术麻醉方案均采用腰硬联合麻醉,穿刺点L3-4,0.75%布比卡因1~2 m L注入蛛网膜下腔。手术结束后即刻关节腔内注射盐酸氢吗啡酮,根据注射剂量大小不同将其分为小剂量组(32例,单次注射0.2~0.3 mg盐酸氢吗啡酮)和大剂量组(32例,单次注射0.3~0.6 mg)。观察两组术后不同时点的视觉模拟评分(VAS)、生理应激反应指标及追加术后疼痛药物(氟比洛芬脂)情况,并统计两组不良反应发生率。结果:两组术后镇痛4 h、8 h、12 h的VAS评分比较,差异均无统计学意义(P>0.05),但小剂量组术后镇痛16 h的VAS评分低于大剂量组,差异具有统计学意义(P<0.05);两组镇痛12 h、24 h的血皮质醇(Cor)、去甲肾上腺素(NE)表达显著高于术毕时点(P<0.05),但两组术毕、镇痛12 h、24 h上述指标比较,差异无统计学意义(P>0.05);小剂量组追加氟比洛芬酯率25.00%、追加次数(1.2±0.4)次分别高于大剂量组18.75%、(1.1±0.3)次,但两组差异并无统计学意义(P>0.05);两组术后血尿、肝肾功能均无异常,两组不良反应率比较差异无统计学意义(P>0.05)。结论:膝关节镜术后腔内注射0.2~0.3 mg盐酸氢吗啡酮能较好抑制生理疼痛应激反应,且并不增加术后追加镇痛药物用量和不良反应。Objective： To investigate the effect of intra-articular injection of hydrochlormorphone hydrochloride on patients after arthroscopic knee surgery. Methods： 64 cases of knee joint operation were selected,spinal and epidural anesthesia were used in the operation anesthesia,puncture point L3-4,0. 75% bupivacaine 1 - 2 m L was injected into subarachnoid space. After operation,hydromorpholone hydrochloride was injected immediately. The patients were divided into small dose group（ 32 cases,single injection of 0. 2 -0. 3 mg hydromorphine hydrochloride） and large dose group（ 32 cases,single injection 0. 3 - 0. 6 mg） according to the injection dose.The visual analogue score（ VAS）,physiological stress response index and postoperatively pain medication（ pareoxib） were observed between the two groups,and the incidence of adverse reactions in the two groups was also studied. Results： There was no significant difference in the VAS scores of 4 h,8 h and 12 h for postoperative analgesia（ P〉0. 05）,but the VAS score of 16 h in the small dose group was lower than the large dose group,and the difference was statistically significant（ P〈 0. 05）. the Cor,NE expression of analgesic 12 h,analgesic 24 h were significantly higher than those at the end of the operation in two groups（ P〈0. 05）,however,there was no significant difference between the two groups in terms of operative completion and analgesia 12 h,24 h（ P〉0. 05）. The rate of supplemental flurbiprofen ester 25%（ 8/32） and the additional number（ 1. 2 ± 0. 4） times in the small dose group were higher than those in the large dose group 18. 75%（ 6/32）,（ 1.1±0.3） times,but there was no statistical significance（ P〈0.05）. There was no abnormal hematuria,liver and kidney function in the two groups. There was no significant difference in the adverse reaction rate between the two groups. Conclusion： Intracavitary injection of 0. 2-0. 3 mg hydromorphine hydrochloride after arthroscopy,can inhibit the stress response to

关 键 词：膝关节镜手术 术后镇痛 盐酸氢吗啡酮 应激反应 

分 类 号：R614[医药卫生—麻醉学]