布比卡因脂质体与盐酸布比卡因局部麻醉对老年胸骨正中切口心脏手术患者术后镇痛效果的比较  

Comparison of Postoperative Analgesia Between Bupivacaine Liposome and Bupivacaine Hydrochloride Local Anesthesia in Elderly Patients Undergoing Cardiac Surgery with Median Sternal Incision

作　　者：张春燕[1] 李焕丽 刘晶晶 刘曙光[1] ZHANG Chunyan;LI Huanli;LIU Jingjing;LIU Shuguang(Department of Anesthesiology,Zhoukou Central Hospital,Zhoukou 466000,China)

机构地区：[1]周口市中心医院麻醉科,河南周口466000

出　　处：《河南医学研究》2024年第15期2795-2799,共5页Henan Medical Research

摘　　要：目的比较布比卡因脂质体(LB)与盐酸布比卡因(BH)局部麻醉在老年胸骨正中切口心脏手术患者中的术后镇痛效果。方法选取2023年9—12月周口市中心医院收治106例老年胸骨正中切口心脏手术患者,随机分为BH组和LB组,各53例。BH组术后切口局部注射BH并使用自控静脉镇痛(PCIA),LB组切口局部注射LB并使用PCIA。术后6、12、24、48、72 h,比较两组患者视觉模拟疼痛评分(VAS)、Ramsay镇静评分、血清疼痛介质[5-羟色胺、P物质、前列腺素E_(2)(PGE_(2))、β内啡肽(β-EP)]、应激激素水平[皮质醇、去甲肾上腺素(NE)]。比较两组术后镇痛药物使用情况、住院时间及不良反应。结果LB组术后24、48、72 h静息及活动状态下VAS评分低于BH组(P<0.05)。LB组术后6、12、24、48、72 h血清5-羟色胺、P物质、PGE_(2)、皮质醇、NE水平低于BH组,β-EP水平高于BH组(P<0.05)。LB组术后首次使用镇痛药物时间长于BH组,术后72 h内阿片类药总用量少于BH组(P<0.05)。LB组与BH组住院时间差异无统计学意义(P>0.05)。LB组不良反应发生率与BH组差异无统计学意义(P>0.05)。结论切口局部注射LB应用于老年开胸手术患者术后镇痛效果显著,能减轻机体应激反应与疼痛介质水平,且对镇静程度无影响,安全性较好。Objective To compare the postoperative analgesic effects of liposome bupivacaine(LB)and bupivacaine hydrochloride(BH)local anesthesia in elderly patients undergoing cardiac surgery with median sternal incision.Methods All 106 elderly patients undergoing cardiac surgery with median sternal incision admitted to Zhoukou Central Hospital from September to December 2023 were selected and randomly divided into BH group and LB group,53 cases in each group.The BH group injected locally BH with postoperative self-controlled intravenous analgesia(PCIA),LB group injected locally LB with PCIA.The visual analogue pain score(VAS),ramsay sedation score,serum pain mediators[5-hydroxytryptamine,Substance P,prostaglandin E_(2)(PGE_(2)),β-endorphin(β-EP)],stress hormone levels[cortisol,norepinephrine(NE)]after 6 h,12 h,24 h,48 h and 72 h of operation,postoperative analgesic drug,length of hospital stay and adverse reactions were compared between BH group and LB group.Results After 24 h,48 h and 72 h of operation,the postoperative VAS scores at resting and active state in LB group were lower than those in the BH group(P<0.05).After 6 h,12 h,24 h,48 h and 72 h of operation,the levels of 5-hydroxytryptamine,substance P,PGE_(2),cortisol,NE in LB group were lower than those in the BH group,the level ofβ-EP was higher than that in BH group(P<0.05).The first use of analgesic drugs in the LB group was longer than that in BH group,the cumulative use of opioids within 72 h after surgery was lower than that in BH group(P<0.05).The hospital stay had no difference between LB group and BH group(P>0.05).The incidence of adverse reactions had no difference between LB group and BH group(P>0.05).Conclusion LB combined with PCIA has significant effect on elderly patients undergoing cardiac surgery with median sternal incision,which can reduce the stress response and the level of pain mediators in patients,and has no influence on the degree of sedation,with good safety.

关 键 词：胸骨正中切口心脏手术 布比卡因脂质体 盐酸布比卡因 疼痛 

分 类 号：R614[医药卫生—麻醉学]