肝脏肿瘤微波消融术中氢吗啡酮与吗啡的 镇痛效果比较  

Comparison of analgesic effects of Hydromorphone and Morphine during microwave ablation of liver tumors

作　　者：牛树国 郑宁刚[2] 刘源 颜克松 谢凡 柴文晓[2] NIU Shuguo;ZHENG Ninggang;LIU Yuan;YAN Kesong;XIE Fan;CHAI Wenxiao(Department of Interventional,Wuwei Traditional Chinese Medicine Hospital,Gansu Province,Wuwei733000,China;Department of Interventional Oncology,Gansu Provincial Hospital,Gansu Province,Lanzhou730000,China)

机构地区：[1]甘肃省武威市中医医院介入科,甘肃武威733000 [2]甘肃省人民医院肿瘤介入科,甘肃兰州730000

出　　处：《中国当代医药》2024年第7期108-113,共6页China Modern Medicine

基　　金：甘肃省自然科学基金项目(22JR5RA687)。

摘　　要：目的比较氢吗啡酮与吗啡在肝脏肿瘤微波消融术(MWA)中的镇痛效果。方法选取2020年11月至2022年1月甘肃省人民医院收治的56例肝脏肿瘤患者作为研究对象,患者均行CT引导下MWA治疗,使用随机数字表法将患者分为试验组(28例)和对照组(28例),对照组脱落3例,最终纳入25例,试验组术中使用氢吗啡酮镇痛,对照组术中使用吗啡镇痛。比较两组患者术前(T_(0))、穿刺时(T_(1))、消融5 min时(T_(2))、消融10 min时(T_(3))术中最大视觉模拟评分法(VAS)评分时的生命体征及VAS评分等,评价两组药物的镇痛效果及安全性。结果两组患者的收缩压和舒张压组间、时间、交互作用比较,差异无统计学意义(P>0.05);试验组中T_(2)及T_(3)时的收缩压高于T_(0)及T_(1)时,差异有统计学意义(P<0.05)。两组患者术中最大VAS评分时呼吸频率比较,试验组低于对照组,差异有统计学意义(P<0.05)。两组患者的总不良反应发生率比较,差异无统计学意义(P>0.05)。结论氢吗啡酮对局部麻醉下肝脏肿瘤MWA中的镇痛效果优于吗啡,二者不良反应发生率接近。术中疼痛会引起收缩压升高,但吗啡可减轻术中血压波动。Objective To compare the analgesic effects of Hydromorphone and Morphine in microwave ablation(MWA)of liver tumors.Methods A total of 56 patients with liver tumors admitted to Gansu Provincial Hospital from November 2020 to January 2022 were selected as the study objects.All patients were treated with CT-guided MWA.Randomized number table method was used to divide the patients into experimental group(28 cases)and control group(28 cases),and in the control group,3 cases fell off,and 25 cases were eventually included.Hydromorphone analgesia was used in experimental group and Morphine analgesia was used in control group.The vital signs at the time of maximum intraoperative visual analogue scale(VAS)score of the two groups before surgery(T_(0)),at puncture(T_(1)),at ablation for 5 min(T_(2))and at ablation for 10 min(T_(3)),VAS score,and etc were compared and the analgesic effect and safety of the two groups were evaluated.Results There was no significant difference in systolic blood pressure and diastolic blood pressure between groups,time and interaction between the two groups(P>0.05).The systolic blood pressure at T_(2) and T_(3) were higher than that at T_(0) and T_(1),and the differences were statistically significant(P<0.05).The respiratory rate of the experimental group was lower than that of the control group at the maximum VAS score,and the difference was statistically significant(P<0.05).There was no significant difference in the incidence of total adverse reactions between the two groups(P>0.05).Conclusion Hydromorphone has better analgesic effect than Morphine in liver tumor MWA under local anesthesia,and the incidence of adverse reactions is similar to that of Morphine.Intraoperative pain can cause systolic blood pressure to increase,but Morphine can reduce intraoperative blood pressure fluctuations.

关 键 词：肝脏肿瘤 微波消融术 镇痛 氢吗啡酮 吗啡 

分 类 号：R735.7[医药卫生—肿瘤]