氢吗啡酮超前镇痛对肠道腔镜手术患者应激反应及术后镇痛效果的影响  

Effects of preemptive analgesia with hydromorphone on stress response and postoperative analgesia in patients undergoing endoscopic intestinal surgery

作　　者：林江怀 邱俊峰 李顺元[1] LIN Jianghuai;QIU Junfeng;LI Shunyuan(Department of Anesthesiology,Quanzhou First Hospital Affiliated to Fujian Medical University,Fujian Province,Quanzhou 362000,China)

机构地区：[1]福建医科大学附属泉州第一医院麻醉科,福建省泉州市362000

出　　处：《临床合理用药杂志》2023年第32期4-7,共4页Chinese Journal of Clinical Rational Drug Use

摘　　要：目的观察氢吗啡酮超前镇痛对肠道腔镜手术患者应激反应及术后镇痛效果的影响。方法选取2020年12月—2021年12月于福建医科大学附属泉州第一医院行肠道腔镜手术患者120例,按照随机数字表法分为观察组和对照组各60例,观察组给予氢吗啡酮超前镇痛,对照组给予常规麻醉。比较2组患者麻醉前(T_(0))、麻醉后5 min(T_(1))及手术结束时(T_(2))的心率(HR)、平均动脉压(MAP),T_(0)、T_(2)时皮质醇、去甲肾上腺素水平,以及术后自主呼吸恢复时间、Ramsay镇静评分、Ricker镇静—躁动评分(SAS评分)、术后疼痛视觉模拟评分法(VAS)评分。结果T_(1)、T_(2)时,2组患者HR、MAP均较T0时升高,但观察组低于对照组(P<0.01);T_(2)时,2组患者皮质醇、去甲肾上腺素水平较T0时均升高,但观察组低于对照组(P<0.05或P<0.01);观察组患者术后自主呼吸恢复时间短于对照组,Ramsay镇静评分、SAS评分少于对照组(P<0.05或P<0.01);术后12、24 h 2组患者VAS评分均低于术后6 h,术后6、24 h观察组VAS评分低于对照组(P<0.05或P<0.01),术后12 h 2组VAS评分比较差异无统计学意义(P>0.05)。结论氢吗啡酮超前镇痛可有效缓解肠道腔镜手术患者应激反应,有效减轻术后疼痛,对预后恢复有积极意义。Objective To observe the effects of preemptive analgesia with hydromorphone on stress response and postoperative analgesia in patients undergoing endoscopic intestinal surgery.Methods From December 2020 to December 2021 in Quanzhou First Hospital Affiliated to Fujian Medical University,120 patients undergoing endoscopic intestinal surgery were randomly divided into the observation group and the control group,with 60 cases in each group.The observation group was given preemptive analgesia with hydromorphone,while the control group was given conventional anesthesia.The heart rate(HR)and mean arterial pressure(MAP)before anesthesia(T_(0)),5 minutes after anesthesia(T_(1))and at the end of surgery(T_(2)),and the levels of cortisol and norepinephrine at T_(0) and T_(2),and the recovery time of spontaneous respiration after surgery,Ramsay sedation score,SAS score and VAS score of postoperative pain were compared between the two groups.Results At T_(1)and T_(2),the HR and MAP in both groups were higher than those at T 0,but the levels of observation group were lower than control group(P<0.01);At T_(2),the levels of cortisol and norepinephrine in both groups were higher than those at T 0,but the levels of observation group were lower than control group;The recovery time of spontaneous respiration after surgery,Ramsay sedation score and SAS score in the observation group were shorter than control group(P<0.05 or P<0.01);The VAS scores at 12 and 24 hours after surgery were lower than those at 6 hours after operation in both groups,and the VAS scores at 6 and 24 hours after surgery in the observation group were lower than control group(P<0.05 or P<0.01);There was no significant difference in the VAS scores between two groups at 12 hours after surgery(P>0.05).Conclusion Preemptive analgesia with hydromorphone can effectively relieve stress response and postoperative pain in patients undergoing endoscopic intestinal surgery,which has positive significance for prognosis and recovery.

关 键 词：肠道腔镜手术 超前镇痛 氢吗啡酮 应激反应 术后镇痛 

分 类 号：R614[医药卫生—麻醉学]