比较氢吗啡酮与舒芬太尼配伍曲马多在剖宫产术后静脉自控镇痛的效果  

Comparison of hydromorphone and sufentanil-tramadol combination in patient-controlled intravenous analgesia for parturients after cesarean section

作　　者：曹雪芹[1] 聂彬[1] 刘琼 李继 何满 张咸伟[1] Cao Xueqin;Nie Bin;Liu Qiong;Li Ji;He Man;Zhang Xianwei(Department of Anesthesiology,Tongji Hospital,Tongji Medical College,Huazhong University of Science and Technology,Wuhan City,Hubei Province 430030,China)

机构地区：[1]华中科技大学同济医学院附属同济医院麻醉科,武汉市430030

出　　处：《中华疼痛学杂志》2021年第6期626-631,共6页Chinese Journal Of Painology

摘　　要：目的比较氢吗啡酮与舒芬太尼配伍曲马多在剖宫产术后静脉自控镇痛中的效果。方法回顾性分析2015年11月至2019年4月在同济医院于椎管内麻醉下行剖宫产术的4831例产妇的临床资料,根据静脉自控镇痛的配方分为两组,氢吗啡酮组(n=2785)和舒芬太尼配伍曲马多组(n=2046)。比较两组术后4~6 h、8~12 h、18~24 h视觉模拟评分(VAS)、Ramsay镇静评分(RSS)、术后24 h内阿片类药物总消耗量和不良反应发生情况。结果术后静息状态时,氢吗啡酮组4~6 h、8~12 h、18~24 h VAS评分分别为(9.9±3.8)、(8.5±4.5)、(6.2±3.5)分;舒芬太尼配伍曲马多组VAS评分分别为(8.2±4.0)、(6.0±3.2)、(4.1±2.0)分。活动状态时,氢吗啡酮组4~6 h、8~12 h、18~24 h VAS评分分别为(18.8±5.8)、(11.8±6.3)、(10.2±6.7)分;舒芬太尼配伍曲马多组VAS评分分别为(14.6±4.1)、(11.6±6.2)、(9.4±5.0)分。不论是静息还是活动状态,氢吗啡酮组VAS评分均大于舒芬太尼配伍曲马多组(P均<0.05),但两组VAS评分均<40,差异并无临床意义(P>0.05)。两组产妇术后4~6 h、8~12 h、18~24 h的Ramsay评分均在2~4分,两组比较均无统计学差异(P均>0.05)。换算成吗啡,术后24 h内,氢吗啡酮组阿片类药物的总消耗量为56.0(17.0)mg,明显少于舒芬太尼配伍曲马多组83.2(30.0)mg(P<0.05)。氢吗啡酮组和舒芬太尼配伍曲马多组术后恶心呕吐的发生率分别为1.9%和2.0%,差异无统计学意义(P>0.05);氢吗啡酮组眩晕、腹胀的发生率分别为0.4%和0.02%,明显低于舒芬太尼配伍曲马多组(眩晕、腹胀发生率分别为1.5%和0.05%),差异均有统计学意义(P均<0.05)。两组均未见呼吸抑制。结论氢吗啡酮和舒芬太尼配伍曲马多静脉自控镇痛均可有效用于剖宫产术后镇痛,但氢吗啡酮静脉自控镇痛不良反应发生率更低,患者可接受程度更高。Objective To compare hydromorphone with sufentanil tramadol combination in patient-controlled intravenous analgesia(PCIA)for parturients'pain relief after cesarean section.Methods Parturients(n=4831)scheduled for cesarean section under neuraxial anesthesia and received PCIA in Tongji Hospital from November 2015 to April 2019,were retrospectively analyzed.These parturients were assigned to hydromorphone group(n=2785),or sufentanil-tramadol combination group(n=2046).Visual analogue scale(VAS)and Ramsay sedation score(RSS)were compared at 4-6 h,8-12 h,18-24 h after the operation between the two groups.Meanwhile,total opioid consumption,and incidence of adverse effects within 24 hours were compared between the two groups.Results VAS was(9.9±3.8),(8.5±4.5)and(6.2±3.5)in hydromorphone group,and(8.2±4.0),(6.0±3.2),(4.1±2.0)in sufentanil-tramadol group at 4-6 h、8-12 h、18-24 h after the operation respectively during rest,(18.8±5.8),(11.8±6.3),(10.2±6.7)or(14.6±4.1),(11.6±6.2),(9.4±5.0)during movement respectively.Though the hydromorphone group had higher VAS during rest and movement than sufentanil-tramadol group at 4-6 h,8-12 h,18-24 h after cesarean section(all P<0.05),VAS was all lower than 40 in both groups,no clinical significance(P>0.05).There was no significant difference in Ramsay scores between the two groups(all scores were 2-4,all P>0.05).The opioid consumption of hydromorphone group was 56.0(17.0)mg after converted to morphine,which was lower than that of sufentanil-tramadol group 83.2(30.0)mg after converted to morphine within 24 hours after the operation.The incidences of postoperative nausea/vomiting in hydromorphone group and sufentanil-tramadol group were 1.9% and 2.0% respectively,and there was no significant difference between the two groups(all P>0.05).The incidences of dizziness and abdominal distension were 0.4% and 0.02% in hydromorphone group,which was lower than those in sufentanil-tramadol group(1.5% and 0.05%)respectively(all P<0.05).Respiratory depression was not observed in eac

关 键 词：舒芬太尼 曲马多 氢吗啡酮 剖宫产 患者自控镇痛 

分 类 号：R614[医药卫生—麻醉学]