【摘要】 目的探讨不同剂量氢吗啡酮用于老年患者术后硬膜外自控镇痛(PCEA)的安全性和有效性。方法选择在腰硬联合麻醉下行全髋关节置换术的老年患者60例,采用随机数字表法将其分为3组(每组各20例):H1组、H2组及S组。手术在腰硬联合麻醉下进行,术毕进行PCEA,镇痛泵配方:H1组氢吗啡酮25μg/kg,H2组氢吗啡酮50μg/kg,S组舒芬太尼1μg/kg,3组均加入1%罗哌卡因20mL及托烷司琼0.1mg/kg,用生理盐水稀释至100mL。背景输注速度2 mL/h,自控0.5 mL/次,锁定时间15 min。观察并记录术毕(T0)、术后4h(T1)、12h(T2)、24h(T3)患者的收缩压(SP)、舒张压(DP)、心率(HR)、氧饱和度(SPO2),镇痛、镇静评分(BS-11及Ramsay评分),以及24hPCEA泵自动进药量(V)、PCA按压次数(P1)和有效次数(P2),记录患者嗜睡、恶心呕吐、皮肤瘙痒及呼吸抑制等不良反应的发生情况。结果 3组患者在T0~T4各时点SP、DP、HR、SPO2、BS-11及Ramsay评分差异均无统计学意义(P>0.05),术后24h H1组和H2组V、P1和P2均低于S组,差异有统计学意义(P<0.05),H2组患者恶心呕吐次数多于H1组及S组(P<0.05)。结论氢吗啡酮联合低浓度罗哌卡因用于老年患者术后PCEA是安全有效的,氢吗啡酮推荐使用剂量为25μg/kg。更多还原

【Abstract】 Objective To investigate the safety and effectiveness of different dosages of hydromorphone for patient controlled epidural analgesia(PCEA)in elderly patients with postoperative.Methods Sixty senile patients treated with total hip replacement under combined spinal-epidural anesthesia were enrolled in the study,and randomly divided into three groups(20cases in each group):group H1,group H2 and group S.Surgery was performed under combined spinal-epidural anesthesia,and PCEA was operated after surgery with different analgesia pump formula:25μg/kg hydromorphone for group H1,50μg/kg hydromorphone for group H2,1μg/kg sufentanil for group S respectively,20 mL 1% ropivacaine and 0.1mg/kg tropisetron were added into each analgesia pump formula,and 100 mL final volume was fixed with saline.The background infusion rate was set at 2mL/h,self-control at 0.5mL per time and the locked time was 15 mins.The SP,DP,HR,SPO2 values,the pain scores and the sedation scores at selected time points T0(0hpost operation),T1(4hpost operation),T2(12hpost operation)and T3(24hpost operation)were monitored and recorded.The infusion volume of PCEA pump in 24h(V),the PCA press number(P1)and the effective number(P2)were also recorded.The occurrence of side reaction such as sleepiness,nausea and vomiting,skin pruritus and respiration inhibition were also investigated.Results There was no statistical significance among the three groups when the SP,DP,HR,SPO2,BS-11 values and Ramsay scores of each time point were compared(P>0.05).The values of V,P1 and P2in group H1 and group H2 were both significantly lower than group S(P<0.05)24hpost operation,and the occurence of patients′nausea and vomiting in group H2 was significantly higher than both of group H1 and group S(P<0.05).Conclusion It is safe and effective to use hydromorphone combinating low concentration ropivacaine in postoperative PCEA for elder patients and the recommended dosage of hydromorphone is 25μg/kg.更多还原