嗎啡和羥考酮用于治療腹腔鏡子宮切除術(shù)后內(nèi)臟痛的安全性和有效性研究
發(fā)布時(shí)間：2018-08-13 18:15
【摘要】：目的:比較鹽酸嗎啡和鹽酸羥考酮低背景劑量聯(lián)合患者自控鎮(zhèn)痛給藥模式在治療腹腔鏡下子宮切除術(shù)后內(nèi)臟痛的安全性和有效性。方法:擇期行腹腔鏡下子宮全切除術(shù)或子宮次全切除術(shù)的女性患者90例,年齡40~60歲,ASAⅠ-Ⅱ級,隨機(jī)將患者分為羥考酮組(O組,n=45)和嗎啡組(M組,n=45)。O組:患者于手術(shù)結(jié)束前10分鐘,靜脈給予羥考酮0.07mg/kg,拔出氣管導(dǎo)管后,靜脈予背景劑量0.01mg/kg/h,單次劑量0.01 mg/kg/次,鎖定時(shí)間15min;M組:患者于手術(shù)結(jié)束前10分鐘,靜脈給予嗎啡0.07mg/kg,拔出氣管導(dǎo)管后,鹽酸嗎啡背景劑量0.01 mg/kg/h,單次劑量0.01 mg/kg/次,鎖定時(shí)間15min。所有患者在手術(shù)前均使用手持式壓力測痛儀用于比較壓力性痛覺閾(PPT)和壓力性耐受閾(PTT)以證明手術(shù)前兩組間具有相似性;麻醉選擇全身麻醉,使用丙泊酚和注射用瑞芬太尼、順式阿曲庫銨進(jìn)行麻醉誘導(dǎo),行經(jīng)口氣管插管。術(shù)中用丙泊酚和瑞芬太尼靶控輸注,順式阿曲庫銨靜脈持續(xù)輸注維持麻醉,手術(shù)結(jié)束縫合切口前,外科醫(yī)生在所有切口區(qū)域內(nèi)注射鹽酸羅哌卡因和腎上腺素混合溶液。術(shù)畢,在麻醉恢復(fù)室(PACU),患者清醒后,拔出氣管插管,分別接受羥考酮(O組)或嗎啡(M組)靜脈滴定,對視覺模擬評分(VAS)為30-50mm的患者靜脈給予1mg羥考酮/1mg嗎啡;對視覺模擬評分vas50mm的患者給予2mg羥考酮/2mg嗎啡,給藥后15min再次對患者進(jìn)行vas評估,重復(fù)以上步驟,直到vas評分小于30mm,連接pca泵。比較兩組患者拔除氣管插管后,蘇醒時(shí)的vas評分;從蘇醒進(jìn)行vas評分開始到連接pca泵之前進(jìn)行嗎啡或羥考酮的消耗量的統(tǒng)計(jì);在手術(shù)結(jié)束后的30分鐘,1、2、3、6和24小時(shí)累計(jì)羥考酮或嗎啡的消耗量和vas評分(靜息和咳嗽時(shí)的vas)及術(shù)后惡心或嘔吐、瘙癢以及呼吸抑制等的發(fā)生情況;用ramsay鎮(zhèn)靜程度評分量表比較兩組患者的鎮(zhèn)靜情況。結(jié)果:患者蘇醒時(shí)vas評分相似,羥考酮組為56mm,嗎啡組為58mm,但從蘇醒到連接pca時(shí),o組患者羥考酮平均消耗量為2.5±0.8mg,m組嗎啡平均消耗量為4.0±1.3mg,o組阿片藥物的消耗量低于m組;24小時(shí)羥考酮累計(jì)消耗量(26.8±10.2mg)顯著低于嗎啡累計(jì)消耗量(35.2±11.1mg);24小時(shí)羥考酮累計(jì)消耗量(17.4±5.5mg)顯著低于嗎啡累計(jì)消耗量(26.8±6.1mg);術(shù)后評估皮膚痛o組和m組無顯著差異,無統(tǒng)計(jì)學(xué)意義;術(shù)后評估內(nèi)臟痛6h和24h時(shí)間點(diǎn)靜息vas評分o組顯著低于m組,m組(6h,24h):35±12mm,36±10mm;o組(6h,24h):27±9mm,24±8mm;術(shù)后3h,6h和24h時(shí)間點(diǎn)咳嗽時(shí)vas評分o組顯著低于m組,o組(3h,6h,24h):27±9mm,27±9mm,24±8mm;m組(3h,6h,24h):35±12mm,35±12mm,36±10mm;羥考酮組患者術(shù)后總體鎮(zhèn)靜水平顯著低于嗎啡組患者(p=0.006);o組惡心嘔吐2人(占5.71%),m組惡心嘔吐5人(占13.89%)(P=0.018),O組少于M組;O組患者未出現(xiàn)瘙癢癥狀,M組患者有1人出現(xiàn)瘙癢(占2.78%)。兩組患者均未出現(xiàn)呼吸抑制。結(jié)論:羥考酮對腹腔鏡下子宮切除術(shù)后內(nèi)臟痛的鎮(zhèn)痛效能優(yōu)于嗎啡,鎮(zhèn)靜等不良反應(yīng)少于嗎啡。
[Abstract]:Aim: to compare the safety and efficacy of morphine hydrochloride and hydroxycodone hydrochloride combined with patient-controlled analgesia in the treatment of visceral pain after laparoscopic hysterectomy. Methods: a total of 90 female patients, aged 40 to 60 years, undergoing laparoscopic hysterectomy or subtotal hysterectomy were randomly divided into two groups: hydroxone group (group O, n = 45) and morphine group (group M, n = 45). After the tracheal catheter was pulled out, the background dose was 0.01 mg / kg / h, the single dose was 0.01 mg/kg/, and the locking time was 15 minutes. The patients were given morphine 0.07 mg / kg 10 minutes before the end of operation, and the tracheal catheter was pulled out. The background dose of morphine hydrochloride was 0. 01 mg / kg / h, the single dose was 0. 01 mg/kg/, and the locking time was 15 minutes. All patients were used to compare the pressure-induced pain threshold (PPT) with the pressure-tolerance threshold (PTT) before the operation, to prove the similarity between the two groups before operation, to choose general anesthesia, to use propofol and remifentanil for injection, to prove the similarity between the two groups before the operation, and to use propofol and remifentanil for injection. Cis-atracurium was induced by anesthesia and intubated by oral tube. Propofol and remifentanil were used for target-controlled infusion and continuous intravenous infusion of cis atracurium was used to maintain the anesthesia. The surgeon injected ropivacaine hydrochloride and epinephrine into all incision areas before the end of the suture of the incision. At the end of the operation, the patients with (PACU), in the anaesthesia recovery room were removed from tracheal intubation and received intravenous titration of hydroxycodone (group O) or morphine (group M) respectively. The patients with visual analogue score (VAS) of 30-50mm were given 1mg hydroxycodone / 1 mg morphine intravenously. Patients with visual analogue score (vas50mm) were given 2mg hydroxycodone / 2 mg morphine. After 15min was administered, the patients were evaluated with vas and repeated the above steps until the vas score was less than 30 mm and the pca pump was connected. The vas scores of the two groups were compared after tracheal intubation was removed and the consumption of morphine or hydroxycodone was measured from the beginning of the vas score to the connection of the pca pump. The cumulative consumption of hydroxycodone or morphine and vas score (vas at rest and cough), postoperative nausea or vomiting, pruritus and respiratory inhibition were recorded 30 minutes after operation. The sedation of the two groups was compared with the ramsay sedative scale. Results: the vas scores of the patients were similar when they woke up. The average consumption of hydroxycodone was 2.5 鹵0.8 mg / m in group A (4.0 鹵1.3 mg / m), and the consumption of opioid in group O was lower than that in group m (24 h) (26.8 鹵10.2mg), which was significantly lower than that in group M (56 mm) and morphine group (58 mm), but the average consumption of hydroxycodone in group O was 2.5 鹵0.8 mg / m from awakening to connection with pca. The average consumption of opioid in group A was 4.0 鹵1.3 mg / m. The cumulative consumption of hydroxycodone (17.4 鹵5.5mg) was significantly lower than that of morphine (26.8 鹵6.1mg), but there was no significant difference between group O and group m in postoperative assessment of skin pain. No statistical significance; The vas score at 6 h and 24 h after operation in group o was significantly lower than that in group m (6 h / 24 h): 1: 35 鹵12 mm / 36 鹵10 mm / min (6 h / 24 h): 24 鹵8 mm; the vas score in group o at 6 h and 24 h after operation was significantly lower than that in group m (27 鹵9 mm 27 鹵9 mm 24 鹵8 mm); the total sedation was 35 鹵12 mm 35 鹵12 mm and 36 鹵10 mm at 6 h and 24 h after operation in the Ketone group, and the total sedation was 35 鹵12 mm 35 鹵12 mm and 36 鹵10 mm at 6 h and 24 h after operation in the Ketone group. The level of nausea and vomiting was significantly lower than that in morphine group (P < 0.006), nausea and vomiting in group M (5.71%), nausea and vomiting in group M (13.89%) (P < 0.018), and that in group M was less than that in group M (2.78%). There was no respiratory inhibition in both groups. Conclusion: the analgesic effect of hydroxycodone on visceral pain after laparoscopic hysterectomy is better than that of morphine.
【學(xué)位授予單位】：西南醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R614
本文編號：2181791
[Abstract]:Aim: to compare the safety and efficacy of morphine hydrochloride and hydroxycodone hydrochloride combined with patient-controlled analgesia in the treatment of visceral pain after laparoscopic hysterectomy. Methods: a total of 90 female patients, aged 40 to 60 years, undergoing laparoscopic hysterectomy or subtotal hysterectomy were randomly divided into two groups: hydroxone group (group O, n = 45) and morphine group (group M, n = 45). After the tracheal catheter was pulled out, the background dose was 0.01 mg / kg / h, the single dose was 0.01 mg/kg/, and the locking time was 15 minutes. The patients were given morphine 0.07 mg / kg 10 minutes before the end of operation, and the tracheal catheter was pulled out. The background dose of morphine hydrochloride was 0. 01 mg / kg / h, the single dose was 0. 01 mg/kg/, and the locking time was 15 minutes. All patients were used to compare the pressure-induced pain threshold (PPT) with the pressure-tolerance threshold (PTT) before the operation, to prove the similarity between the two groups before operation, to choose general anesthesia, to use propofol and remifentanil for injection, to prove the similarity between the two groups before the operation, and to use propofol and remifentanil for injection. Cis-atracurium was induced by anesthesia and intubated by oral tube. Propofol and remifentanil were used for target-controlled infusion and continuous intravenous infusion of cis atracurium was used to maintain the anesthesia. The surgeon injected ropivacaine hydrochloride and epinephrine into all incision areas before the end of the suture of the incision. At the end of the operation, the patients with (PACU), in the anaesthesia recovery room were removed from tracheal intubation and received intravenous titration of hydroxycodone (group O) or morphine (group M) respectively. The patients with visual analogue score (VAS) of 30-50mm were given 1mg hydroxycodone / 1 mg morphine intravenously. Patients with visual analogue score (vas50mm) were given 2mg hydroxycodone / 2 mg morphine. After 15min was administered, the patients were evaluated with vas and repeated the above steps until the vas score was less than 30 mm and the pca pump was connected. The vas scores of the two groups were compared after tracheal intubation was removed and the consumption of morphine or hydroxycodone was measured from the beginning of the vas score to the connection of the pca pump. The cumulative consumption of hydroxycodone or morphine and vas score (vas at rest and cough), postoperative nausea or vomiting, pruritus and respiratory inhibition were recorded 30 minutes after operation. The sedation of the two groups was compared with the ramsay sedative scale. Results: the vas scores of the patients were similar when they woke up. The average consumption of hydroxycodone was 2.5 鹵0.8 mg / m in group A (4.0 鹵1.3 mg / m), and the consumption of opioid in group O was lower than that in group m (24 h) (26.8 鹵10.2mg), which was significantly lower than that in group M (56 mm) and morphine group (58 mm), but the average consumption of hydroxycodone in group O was 2.5 鹵0.8 mg / m from awakening to connection with pca. The average consumption of opioid in group A was 4.0 鹵1.3 mg / m. The cumulative consumption of hydroxycodone (17.4 鹵5.5mg) was significantly lower than that of morphine (26.8 鹵6.1mg), but there was no significant difference between group O and group m in postoperative assessment of skin pain. No statistical significance; The vas score at 6 h and 24 h after operation in group o was significantly lower than that in group m (6 h / 24 h): 1: 35 鹵12 mm / 36 鹵10 mm / min (6 h / 24 h): 24 鹵8 mm; the vas score in group o at 6 h and 24 h after operation was significantly lower than that in group m (27 鹵9 mm 27 鹵9 mm 24 鹵8 mm); the total sedation was 35 鹵12 mm 35 鹵12 mm and 36 鹵10 mm at 6 h and 24 h after operation in the Ketone group, and the total sedation was 35 鹵12 mm 35 鹵12 mm and 36 鹵10 mm at 6 h and 24 h after operation in the Ketone group. The level of nausea and vomiting was significantly lower than that in morphine group (P < 0.006), nausea and vomiting in group M (5.71%), nausea and vomiting in group M (13.89%) (P < 0.018), and that in group M was less than that in group M (2.78%). There was no respiratory inhibition in both groups. Conclusion: the analgesic effect of hydroxycodone on visceral pain after laparoscopic hysterectomy is better than that of morphine.
【學(xué)位授予單位】：西南醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R614
【參考文獻(xiàn)】
相關(guān)期刊論文 前1條
1 徐建國,周志宏,李偉彥,沈憶琴;硬膜外小劑量嗎啡中樞呼吸調(diào)節(jié)抑制效應(yīng)的臨床觀察[J];中華麻醉學(xué)雜志;1995年12期
，本文編號：2181791
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