氢吗啡酮复合曲马多在结核性脓胸患者术后静脉自控镇痛中的应用效果  

Effect of Hydromorphone Combined with Tramadol on Postoperative Intravenous Patient-Controlled Analgesia in Patients with Tuberculous Empyema

作　　者：叶霞 王璐 YE Xia;WANG Lu(Department of Anesthesiology,Xi'an Chest Hospital,Xi'an Shaanxi 710061;不详)

机构地区：[1]西安市胸科医院手麻科,陕西西安710061 [2]安医学院第二附属医院手麻科,陕西西安710038

出　　处：《医学临床研究》2024年第9期1378-1381,共4页Journal of Clinical Research

摘　　要：【目的】探讨氢吗啡酮复合曲马多在结核性脓胸患者术后静脉自控镇痛(PCIA)中的应用效果。【方法】104例结核性脓胸患者,随机分为对照组与观察组,每组52例。术后,对照组采用曲马多行PCIA,观察组采用氢吗啡酮复合曲马多行PCIA。比较两组患者术后不同时间的镇痛效果、呼吸循环指标及认知功能,术前、术后18 h应激指标[皮质醇(Cor)、C反应蛋白(CRP)]及不良反应发生情况。【结果】两组患者术后6 h、18 h、24 h的视觉模拟评分法(VAS)评分较术后3 h均升高(P<0.05),术后18 h的VAS评分较术后6 h均升高(P<0.05),术后24 h的VAS评分较术后18 h均降低(P<0.05);观察组术后6 h、18 h及24 h的VAS评分均低于对照组(P<0.05)。两组患者术后CRP、Cor水平较术前均升高,但观察组低于对照组(P<0.05)。术后12 h,观察组心率(HR)、呼吸频率(RR)低于对照组,血氧饱和度(SpO_(2))高于对照组(P<0.05)。与术前比较,两组术后18 h的蒙特利尔认知评估量表(MoCA)评分均降低(P<0.05),但观察组高于对照组(P<0.05);与术后18 h比较,两组术后24 h的MoCA评分均升高(P<0.05);两组术前、术后24 h MoCA评分比较,差异无统计学意义(P>0.05);观察组不良反应总发生率低于对照组(P<0.05)。【结论】氢吗啡酮复合曲马多应用于结核性脓胸患者术后镇痛中,有利于缓解患者的疼痛感,减少对认知功能的影响,改善应激指标,降低不良反应的发生率。【Objective】To explore the effect of hydromorphone combined with tramadol on postoperative intravenous patient-controlled analgesia(PCIA)in patients with tuberculous empyema.【Methods】A total of 104 patients with tuberculous empyema were randomly divided into the control and the observation groups,with 52 cases in each group.Postoperatively,the control group received tramadol for PCIA,while the observation group received hydromorphone combined with tramadol for PCIA.The postoperative analgesic effect,respiratory and circulatory indicators,and cognitive function at different time points were compared between the two groups.Stress indicators[cortisol(Cor),C-reactive protein(CRP)]before and 18 h after surgery and the incidence of adverse reactions were also compared.【Results】The visual analog scale(VAS)pain scores at 6 h,18 h,and 24 h postoperatively were higher than those at 3 h postoperatively in both groups(P<0.05).In both groups,the VAS scores at 18 h postoperatively were higher than those at 6 h postoperatively(P<0.05),while the VAS scores at 24 h postoperatively were lower than those at 18 h postoperatively(P<0.05).Compared to the control group,the VAS scores at 6 h,18 h,and 24 h postoperatively were lower in the observation group(P<0.05).The postoperative CRP and Cor levels were higher than the preoperative levels in both groups,with the observation group showing lower levels than the control group(P<0.05).At 12 h postoperatively,the heart rate(HR)and respiratory rate(RR)were lower,and the oxygen saturation(SpO_(2))was higher in the observation group compared to the control group(P<0.05).Compared to preoperative levels,the Montreal Cognitive Assessment(MoCA)scores at 18 h postoperatively were lower in both groups(P<0.05),while the score of MoCA in the observation group was higher than that in the control group(P<0.05).Compared to MOCA scores at 18 h postoperatively,the MoCA scores at 24 h postoperatively were higher in both groups(P<0.05).There was no statistically significant difference in the MoCA

关 键 词：脓胸 结核性/外科学 氢吗啡酮/治疗应用 曲马多/治疗应用 镇痛 

分 类 号：R655.6[医药卫生—外科学]