节点文献
硬膜外腔注射不同剂量盐酸氢吗啡酮对子宫切除术后疼痛及应激反应的影响
Effects of epidural hydromorphine injection at various doses on the pain and stress response after hysterectomy
【摘要】 目的:观察不同剂量氢吗啡酮硬膜外腔单次注射对子宫切除术后患者的镇痛效果及其应激反应的影响。方法:选择开放式子宫切除术患者90例,随机、双盲法等分为H1,H2和H33组,均于腰-硬联合麻醉下完成手术后,即切口缝合完毕时,分别向硬膜外腔注射含氢吗啡酮0.3,0.5,1.0 mg及罗哌卡因7.5 mg的混合液5 m L,用于术后镇痛。对照观察术后6 h(T1)、12 h(T2)和24 h(T3)3个时点各组的VAS评分和Ramsay评分,以及镇痛期间嗜睡、恶心、呕吐、皮肤瘙痒和呼吸抑制等不良反应的发生率。同时,于麻醉前(T0)和T1,T2,T34个时点测定各组的血糖和血浆皮质醇浓度。结果:T1时点各组间VAS评分比较无明显差异(P>0.05);T2和T3时点,与H1组、H2组比较,H3组的VAS评分均明显降低(P<0.05),且H2组VAS评分较H1组明显降低(P<0.05)。不同时点各组Ramsay评分比较无明显差异(P>0.05)。镇痛期间,各组呼吸抑制、嗜睡、恶心、呕吐、皮肤瘙痒等不良反应发生率无明显差异(P>0.05)。T0时点,各组的血糖和血浆皮质醇水平无明显差异(P>0.05);T1T3时点,各组的血糖和血浆皮质醇水平均明显高于T0时点(P<0.05);T2和T3时点,H2组和H3组的血糖和血浆皮质醇水平较H1组明显降低(P<0.05)。结论:不同剂量氢吗啡酮硬膜外单次注射用于子宫切除术后镇痛均有较好效果,并能减轻术后应激反应,且0.5 mg剂量的氢吗啡酮临床效果更为满意。
【Abstract】 Objective: To observe the analgesic and stress-relieving effects of single epidural injection of hydromorphone at various doses in patients after hysterectomy. Methods: Open hysterectomy was performed in 90 patients,and they were randomly and double-blindly divided into three groups( H1,H2,H3). At the end of combined spinal-epidural anesthesia after surgery,when the incisions were closed,5 m L mixture containing hydromorphone 0. 3,0. 5 and 1. 0 mg and ropivacaine 7. 5 mg was injected into the epidural cavity for postoperative analgesia. Postoperative VAS scores and Ramsay scores were recorded and compered at 6 h( T1),12 h( T2) and24 h( T3) after surgery. At the same time-points,the incidence of pain during drowsiness,nausea and vomiting,skin itching,respiratory depression and other adverse reactions were also observed. Meanwhile,blood glucose and plasma cortisol concentrations were determined before anesthesia( T0) and at T1,T2,and T3. Results: At T1,VAS scores showed no significant difference( P > 0. 05) in the 3 groups. At T2 and T3,VAS scores in H3 group were significantly decreased as compared with H1 and H2 groups( P < 0. 05). VAS scores were significantly lower in H2 group than in H1 group( P < 0. 05). Ramsay scores showed no significant difference in 3 groups at each time-point( P > 0. 05). During analgesia,adverse reactions including respiratory depression,drowsiness,nausea,vomiting,skin itching and other reactions showed no significant difference in 3 groups( P > 0. 05). Blood glucoseand plasma cortisol levels were no significant difference between three groups at T0( P > 0. 05),but were significantly higher at T1,T2 and T3 than at T0( P < 0. 05). At T2 and T3,blood glucose and plasma cortisol levels were significantly lower in H2 and H3 groups than in H1 group( P < 0. 05). Conclusion: Single epidural injection of different dose hydromorphone for analgesia after hysterectomy has satisfactory effects,and can reduce the stress reactions after operation. The dose of 0. 5 mg dihydromorphinone is more optimal clinically.
【Key words】 shydromorphone hydrochloride; hysterectomy; epidural analgesia; stress response;
- 【文献出处】 中国新药杂志 ,Chinese Journal of New Drugs , 编辑部邮箱 ,2018年17期
- 【分类号】R614
- 【被引频次】7
- 【下载频次】123