氢吗啡酮混合右美托咪定患者自控静脉镇痛在肾移植术后镇痛中的应用效果  

The systemic evaluation of efficacy and safety of hydromorphone combined with dexmedetomidine on PCIA after renal transplantation

作　　者：尹万鹏 尚宇 王玉 于童 张祥超 关双成 YIN Wan-peng;SHANG Yu;WANG Yuy YU Tong;ZHANG Xiang-chao;GUAN Shuang-cheng(The Norther Theater Air Force Hospital of PLA Postgraduate Training Base of Jinzhou Medical University,Shenyang 110042,Liaoning,China)

机构地区：[1]锦州医科大学中国人民解放军北部战区空军医院研究生培养基地,辽宁沈阳110042 [2]中国人民解放军北部战区空军医院麻醉科,辽宁沈阳110042 [3]沈阳市第十人民医院麻醉科,辽宁沈阳110044

出　　处：《广东医学》2019年第23期3303-3307,共5页Guangdong Medical Journal

基　　金：辽宁省科学技术计划项目(编号:2015020416,201601424,201602756)

摘　　要：目的探讨氢吗啡酮混合右美托咪定在肾移植术后患者自控静脉镇痛(PCIA)中应用的效果和安全性。方法拟行同种异体肾移植术患者60例,年龄25~53岁,体重48~82 kg,ASAⅡ或Ⅲ级。随机双盲抽签法分两组,每组30例。术后均采用PCIA,H组:氢吗啡酮8 mg+托烷司琼5 mg,HD组:氢吗啡酮6 mg+右美托咪定0.1μg/(kg·h)+托烷司琼5 mg,均用生理盐水配成100 mL。参数设置:输注速率2 mL/h,单次剂量0.5 mL,锁定时间15 min。于术后4、12、24、48 h记录VAS、Ramsay评分,记录术后48 h内恶心呕吐、皮肤瘙痒和呼吸抑制等不良反应发生情况。分别于麻醉前2 h及术后24、48 h采静脉血标本,检测血内皮素(ET)、尿素氮(BUN)、肌酐(Cr),记录尿量。结果与H组比较,HD组术后各时点M-VAS评分降低,Ramsay评分升高,术后24和48 h时ET、BUN、Cr浓度降低,尿量增加,术后镇痛补救率、PCIA有效按压次数减少,恶心、呕吐和皮肤瘙痒发生率降低,差异有统计学意义(P<0.05)。结论氢吗啡酮混合右美托咪定用于肾移植术后PCIA,镇痛效果确切,不良反应少,促进移植肾功能恢复,效果优于单独应用氢吗啡酮。Objective To evaluate the efficacy and safety of hydromorphone(HD)combined with dexmedetomidine of PCIA on renal transplantation patients.Methods Sixty allograft renal transplantation patients(ASAⅡorⅢ,age 25-53,and weight 48-82 kg)were randomly divided into 2 groups(n=30).PCIA were used in all postoperative patients.The patients in Group H received HD(8 mg)plus tropisetron(5 mg),while those in Group HD received HM(6 mg),dexmedetomidine[0.1μg/(kg·h)]and tropisetron(5 mg).The VAS and Ramsay score were recorded 4,12,24 and 48 hours after operation.The incidence of adverse reactions such as nausea,voiting,pruritus,and respiratory depression,were recorded.The levels of blood ET,BUN and Cr contents,and urine volume were recorded 2 hours before anesthesia and 24 and 48 hours after operation.Results Compared with Group H,ET,BUN and Cr in the Group HD were significantly reduced,while the urine output was significantly increased 24 and 48 h after operation(P<0.05).VAS score,analgesic remedy,effective pressing time of PCIA,the incidence of nausea and vomiting were significantly reduced in the Group HD(P<0.05).Ramsay sedation score was significantly better in Group HD than Group H(P<0.05).Conclusion Administration of hydromorphone combined with dexmedetomidine on PCIA after renal transplantation provides definite analgesic efficacy and less adverse reactions and promotes the recovery of renal graft function than using hydromorphone alone.

关 键 词：氢吗啡酮 右美托咪定 自控静脉镇痛 肾移植 

分 类 号：R614[医药卫生—麻醉学] R617[医药卫生—外科学]