吗啡和羟考酮用于治疗腹腔镜子宫切除术后内脏痛的安全性和有效性研究
发布时间：2018-08-13 18:15
【摘要】：目的:比较盐酸吗啡和盐酸羟考酮低背景剂量联合患者自控镇痛给药模式在治疗腹腔镜下子宫切除术后内脏痛的安全性和有效性。方法:择期行腹腔镜下子宫全切除术或子宫次全切除术的女性患者90例,年龄40~60岁,ASAⅠ-Ⅱ级,随机将患者分为羟考酮组(O组,n=45)和吗啡组(M组,n=45)。O组:患者于手术结束前10分钟,静脉给予羟考酮0.07mg/kg,拔出气管导管后,静脉予背景剂量0.01mg/kg/h,单次剂量0.01 mg/kg/次,锁定时间15min;M组:患者于手术结束前10分钟,静脉给予吗啡0.07mg/kg,拔出气管导管后,盐酸吗啡背景剂量0.01 mg/kg/h,单次剂量0.01 mg/kg/次,锁定时间15min。所有患者在手术前均使用手持式压力测痛仪用于比较压力性痛觉阈(PPT)和压力性耐受阈(PTT)以证明手术前两组间具有相似性;麻醉选择全身麻醉,使用丙泊酚和注射用瑞芬太尼、顺式阿曲库铵进行麻醉诱导,行经口气管插管。术中用丙泊酚和瑞芬太尼靶控输注,顺式阿曲库铵静脉持续输注维持麻醉,手术结束缝合切口前,外科医生在所有切口区域内注射盐酸罗哌卡因和肾上腺素混合溶液。术毕,在麻醉恢复室(PACU),患者清醒后,拔出气管插管,分别接受羟考酮(O组)或吗啡(M组)静脉滴定,对视觉模拟评分(VAS)为30-50mm的患者静脉给予1mg羟考酮/1mg吗啡;对视觉模拟评分vas50mm的患者给予2mg羟考酮/2mg吗啡,给药后15min再次对患者进行vas评估,重复以上步骤,直到vas评分小于30mm,连接pca泵。比较两组患者拔除气管插管后,苏醒时的vas评分;从苏醒进行vas评分开始到连接pca泵之前进行吗啡或羟考酮的消耗量的统计;在手术结束后的30分钟,1、2、3、6和24小时累计羟考酮或吗啡的消耗量和vas评分(静息和咳嗽时的vas)及术后恶心或呕吐、瘙痒以及呼吸抑制等的发生情况;用ramsay镇静程度评分量表比较两组患者的镇静情况。结果:患者苏醒时vas评分相似,羟考酮组为56mm,吗啡组为58mm,但从苏醒到连接pca时,o组患者羟考酮平均消耗量为2.5±0.8mg,m组吗啡平均消耗量为4.0±1.3mg,o组阿片药物的消耗量低于m组;24小时羟考酮累计消耗量(26.8±10.2mg)显著低于吗啡累计消耗量(35.2±11.1mg);24小时羟考酮累计消耗量(17.4±5.5mg)显著低于吗啡累计消耗量(26.8±6.1mg);术后评估皮肤痛o组和m组无显著差异,无统计学意义;术后评估内脏痛6h和24h时间点静息vas评分o组显著低于m组,m组(6h,24h):35±12mm,36±10mm;o组(6h,24h):27±9mm,24±8mm;术后3h,6h和24h时间点咳嗽时vas评分o组显著低于m组,o组(3h,6h,24h):27±9mm,27±9mm,24±8mm;m组(3h,6h,24h):35±12mm,35±12mm,36±10mm;羟考酮组患者术后总体镇静水平显著低于吗啡组患者(p=0.006);o组恶心呕吐2人(占5.71%),m组恶心呕吐5人(占13.89%)(P=0.018),O组少于M组;O组患者未出现瘙痒症状,M组患者有1人出现瘙痒(占2.78%)。两组患者均未出现呼吸抑制。结论:羟考酮对腹腔镜下子宫切除术后内脏痛的镇痛效能优于吗啡,镇静等不良反应少于吗啡。
[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 卤0.8 mg / m in group A (4.0 卤1.3 mg / m), and the consumption of opioid in group O was lower than that in group m (24 h) (26.8 卤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 卤0.8 mg / m from awakening to connection with pca. The average consumption of opioid in group A was 4.0 卤1.3 mg / m. The cumulative consumption of hydroxycodone (17.4 卤5.5mg) was significantly lower than that of morphine (26.8 卤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 卤12 mm / 36 卤10 mm / min (6 h / 24 h): 24 卤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 卤9 mm 27 卤9 mm 24 卤8 mm); the total sedation was 35 卤12 mm 35 卤12 mm and 36 卤10 mm at 6 h and 24 h after operation in the Ketone group, and the total sedation was 35 卤12 mm 35 卤12 mm and 36 卤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.
【学位授予单位】：西南医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R614
本文编号：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 卤0.8 mg / m in group A (4.0 卤1.3 mg / m), and the consumption of opioid in group O was lower than that in group m (24 h) (26.8 卤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 卤0.8 mg / m from awakening to connection with pca. The average consumption of opioid in group A was 4.0 卤1.3 mg / m. The cumulative consumption of hydroxycodone (17.4 卤5.5mg) was significantly lower than that of morphine (26.8 卤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 卤12 mm / 36 卤10 mm / min (6 h / 24 h): 24 卤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 卤9 mm 27 卤9 mm 24 卤8 mm); the total sedation was 35 卤12 mm 35 卤12 mm and 36 卤10 mm at 6 h and 24 h after operation in the Ketone group, and the total sedation was 35 卤12 mm 35 卤12 mm and 36 卤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.
【学位授予单位】：西南医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R614
【参考文献】
相关期刊论文 前1条
1 徐建国,周志宏,李伟彦,沈忆琴;硬膜外小剂量吗啡中枢呼吸调节抑制效应的临床观察[J];中华麻醉学杂志;1995年12期
，本文编号：2181791
本文链接：https://www.wllwen.com/yixuelunwen/mazuiyixuelunwen/2181791.html
最近更新
教材专著
