盐酸氢吗啡酮对腹腔镜胆囊切除患者血流动力学和苏醒质量的影响

目的:观察应用盐酸氢吗啡酮对腹腔镜胆囊切除(laparoscopic cholecystectomy,LC)患者血流动力学和苏醒质量的影响。方法:选择择期LC患者80例,按照随机数字表法分为研究组(盐酸氢吗啡酮组)和对照组(常规方法组),每组各40例。研究组在麻醉诱导后,手术CO2气腹建立前15 min静脉注射氢吗啡酮2 mg,对照组不予干预。比较麻醉诱导前(T0)、气腹建立时(T1)、气腹撤离时(T2)、清醒拔出气管导管时(T3)、拔管后10 min(T4)、拔管后30 min(T5)的血流动力学改变,并对患者苏醒期质量予以评价。结果:两组患者T0时的收缩压(SBP)、舒张压(DBP)、平均动脉压(MAP)、心率(HR)无统计学意义(P>0.05)。而在T1、T2、T3、T4、T5时点,研究组SBP、DBP、MAP、HR无明显波动,对照组SBP、DBP、MAP、HR均出现一定幅度的波动,两组各时点比较差异有统计学意义(P<0.05)。研究组和对照组在T3、T4、T5时点的苏醒期质量评分(RS)对比有显著性差异(P<0.05)。结论:盐酸氢吗啡酮在全麻LC中应用,可显著抑制不良应激反应,维持血流动力学平稳,改善苏醒质量,使患者得以快速康复,值得临床推广应用。     

Community hospital decreases narcotic usage in postoperative bariatric patients

BackgroundOpioids have long been used as an effective form of analgesia for pain in the postoperative setting; however, their addictive potential and associated complications have become a detriment. There has been an increasing movement to decrease opioid prescribing.ObjectiveThe aim of this study was to look at common bariatric surgery procedures at a single institution and compare opioid usage before and after the implementation of a multimodal pain regimen.SettingCommunity program, hospital-employed, and private practice, United States.MethodsSix hundred twelve laparoscopic gastric bypass and laparoscopic sleeve gastrectomy patients were included in this single-institution retrospective cohort study. Data were obtained from chart review. Comparison was made between patients from 2016 and patients from a 3-month period in 2017 when the new pain management protocol had been instituted.ResultsThe postoperative opioid usage of 516 patients from 2016 was compared with that of 96 patients from a 3-month period in 2017 after initiating the new pain management protocol. The mean intravenous hydromorphone usage of the control group, 16.0 ± 14.6 morphine milligram equivalent (or 4.0 mg ± .2), over the postoperative inpatient stay decreased to 7.3 ± 6.7 morphine milligram equivalent (or 1.8 mg ± .2) in the study group. This represents a 55% decrease. The study group did show less 30-day postoperative complications compared with the control, 1.04% and 2.13%, respectively, although this was not statistically significant.ConclusionA multimodal pain regimen is an effective way to cut opioid usage with no statistical difference in overall 30-day complications.     

腹横肌平面阻滞联合氢吗啡酮对腹腔镜结直肠癌手术患者应激反应及术后镇痛的影响

目的 探讨腹横肌平面阻滞（TAPB）联合氢吗啡酮静脉用药对腹腔镜结直肠癌根治术患者应激反应及术后镇痛的影响。
方法 选择择期全身麻醉下行腹腔镜结直肠癌根治术的患者119例,男43例,女76例,年龄40～64岁,BMI<28 kg/m²,ASA Ⅱ或Ⅲ级。采用随机数字表法将患者分为四组：TAPB组（T组,n=29）、氢吗啡酮静脉用药组（H组,n=31）、TAPB联合氢吗啡酮静脉用药组（TH组,n=30）和对照组（C组,n=29）。记录诱导前10 min和拔管后5 min的血浆肾上腺素（E）和去甲肾上腺素（NE）浓度。记录术中丙泊酚、瑞芬太尼、阿托品、去氧肾上腺素、艾司洛尔、乌拉地尔的使用情况。记录拔管后5 min、1、6、12 h的VAS疼痛评分和Ricker镇静-躁动评分（SAS）。记录术后24 h内镇痛泵有效按压次数、舒芬太尼用量、补救镇痛例数。记录拔管后24 h内恶心呕吐、低血压、呼吸抑制、皮肤瘙痒等不良反应的发生情况。
结果 与诱导前10 min比较,拔管后5 min四组血浆E和NE浓度明显升高（P<0.05）。与C组比较,拔管后5 min,T组、H组和TH组血浆E、NE浓度明显降低（P<0.05）。与TH组比较,T组和H组血浆E、NE浓度明显升高（P<0.05）。与C组比较,拔管后5 min、1、6 h,T组和TH组VAS疼痛评分和SAS评分明显降低（P<0.05）。与TH组比较,拔管后5 min、1、6 h,T组和H组VAS疼痛评分明显增加（P<0.05）。与C组比较,T组、H组和TH组术中丙泊酚和瑞芬太尼用量、去氧肾上腺素使用比例、镇痛泵有效按压次数及舒芬太尼用量明显减少,补救镇痛比例明显降低（P<0.05）。与TH组比较,T组和H组术中丙泊酚和瑞芬太尼用量、去氧肾上腺素使用比例、镇痛泵有效按压次数及舒芬太尼用量明显增加（P<0.05）。四组拔管后24 h内恶心呕吐、呼吸抑制、皮肤瘙痒、便秘等不良反应发生率差异无统计学意义。
结论 与单用腹横肌平面阻滞或氢吗啡酮静脉用药相比,两者联合使用能够减轻腹腔镜结直肠癌根治术患者的应激反应,提供更好的术后早期镇痛效果。     

盐酸氢吗啡酮不同镇痛模式的镇痛效果和不良反应对比研究

目的:研究盐酸氢吗啡酮不同镇痛模式的镇痛效果和不良反应,为其临床应用提供借鉴.方法:选取2008年4月～2012年6月入住我院的肺癌术后将进行镇痛的患者为研究对象,随机分为3组,对照组、实验组a、实验组b,每组各20例,对照组予以常规麻醉,实验组a在常规麻醉的基础上予以静注盐酸氢吗啡酮2 mg q20 min,实验组b则在常规麻醉的基础上予以经脉泵入盐酸氢吗啡酮0.3mg/h,监测术后疼痛评分,观察不良反应.结果:实验组a6、9、12、24、36h时点的Ramsay评分均高于对照组,差异有统计学意义(P＜0.01),实验组b9、12、24、36 h时点的Ramsay评分均高于对照组,差异有统计学意义(P＜0.01),实验组a、b患者具有更好的镇静效果.实验组a和实验组b6h的Ramsay积分比较,差异有统计学意义(P＜0.01),实验组a高于实验组b;其余各时点的Ramsay评分比较,差异均无统计学意义(P＞0.05).3组患者不良反应比较,差异无统计学意义(P＞0.05),实验组b患者尿潴留发生率较其他两组高(P＜0.05).累积不良反应发生率在实验组a为23.3％,对照组为20％,实验组b为43.3％.结论:盐酸氢吗啡酮在停机后间断小剂量给予,进行超前镇痛,可明显降低患者术后VAS评分,且作用至少维持到术后36时;能明显改善患者术后的镇静Ramsay评分,降低术后患者的心率,稳定血流动力学,减少术后镇痛药物的用量,不增加不良反应发生率,值得临床进一步探索和应用.     

术前应用盐酸氢吗啡酮防止腹腔镜胆囊切除术苏醒期躁动的效果

目的观察术前应用盐酸氢吗啡酮在防止腹腔镜胆囊切除术苏醒期躁动的效果。方法选择ASAⅠ~Ⅱ级择期行腹腔镜胆囊切除术患者60例,随机分为盐酸氢吗啡酮组(M组)30例和生理盐水组(N组)30例。M组在手术切皮前15 min给予氢吗啡酮2 mg皮下注射,N组在手术切皮前15 min给予生理盐水2 ml皮下注射,观察记录拔管后5、15、30、45 min时的苏醒期躁动评分(RS)。结果 M组和N组在拔管后5 min和15 min时的苏醒期躁动评分(RS)对比有统计学差异(P<0.05)。结论术前应用盐酸氢吗啡酮能有效防止腹腔镜胆囊切除术苏醒期躁动。     

Effects of buprenorphine versus buprenorphine/naloxone tablets in non-dependent opioid abusers

Rationale: Buprenorphine is an opioid agonist-antagonist under development in the United States as a sublingual medication for treatment of opioid dependence. Buprenorphine may be abused; therefore, tablets combining buprenorphine with naloxone have been developed with the intent of reducing the abuse risk in people physically dependent upon opioids. The characteristics and abuse potential of buprenorphine and buprenorphine/naloxone tablets in non-dependent opioid abusers have not been determined. Non-parenteral abuse of opioids such as buprenorphine may be more likely in people who have less severe substance abuse disorders (e.g., are not physically dependent upon opioids). Objectives: To assess the abuse potential of sublingual buprenorphine and buprenorphine/naloxone tablets in non-dependent opioid abusers. Methods: Subjects (n=7) were tested with sublingual buprenorphine (4, 8, 16 mg), sublingual buprenorphine/naloxone (1/0.25, 2/0.5, 4/1, 8/2, 16/4 mg), as well as intramuscular hydromorphone as an opioid agonist control (2, 4 mg) and placebo in laboratory sessions conducted twice per week. Dosing was double-blind and double-dummy. Results: The higher doses of both buprenorphine and buprenorphine/naloxone produced similar opioid agonist-like effects. The onset of these effects was slowed, consistent with the sublingual route of administration, and the magnitude of effects was moderate. There was no evidence to suggest the addition of naloxone attenuated buprenorphine’s opioid agonist effects in this population when buprenorphine was delivered by the sublingual route. Conclusions: These results suggest that sublingual buprenorphine and buprenorphine/naloxone may both be abused by opioid users who are not physically dependent upon opioids. Received: 15 April 1999 / Final version: 11 September 1999     

Hydromorphone effects on human conversational speech

The present study provides an objective assessment of the increased talkativeness associated with acute opiate drug administration. Speech of five methadone-maintenance subjects was recorded continuously for 1 h following the injection of 0, 10, 14, or 18 mg hydromorphone. Dose-related increases in subjects' speech were observed, while no systematic changes were seen in speech of an undrugged partner. Dose-related increases were also obtained on an adjective checklist measuring characteristic opiate signs and symptoms. The relationship between behavioral, subjective, and reinforcing drug effects is discussed.     

氢吗啡酮静脉自控镇痛对乳腺癌术后疼痛的控制作用及对患者血清5-HT和hs-CRP的影响

摘 要 目的： 探讨氢吗啡酮静脉自控镇痛（PCIA）对乳腺癌术后疼痛的控制作用和安全性,及其对患者血清5 羟色胺（5-HT）和超敏C反应蛋白（hs-CRP）的影响。 方法: 行改良根治术治疗的乳腺癌患者100例随机分为舒芬太尼组和氢吗啡酮组各50例。术后舒芬太尼组给予舒芬太尼PCIA,氢吗啡酮组给予氢吗啡酮PCIA。分别应用视觉模拟评分法(VAS)、Ramsay评分于术后2,6,12,18,24 h评估观察患者镇痛和镇静效果,记录两组患者24h PCIA泵自动进药量、按压次数、实际有效进药次数,以及两组药品不良反应发生情况;分别于术后2h和术后24h检测血清5-HT和hs-CRP水平。结果: 氢吗啡酮组患者术后12h、18h和24h 的VAS评分和Ramsay评分均明显低于舒芬太尼组(P＜0.05);术后24 h自动进药量、按压次数、实际有效进药次数均明显低于舒芬太尼组(P＜0.05)。两组患者术后24 h血清5-HT和hs-CRP水平均较前显著升高(P＜0.05),而氢吗啡酮组术后24 h血清5-HT和hs-CRP水平低于舒芬太尼组(P＜0.05)。两组患者不良反应发生率差异无统计学意义（P＞0.05）。 结论: 乳腺癌术后应用氢吗啡酮PCIA,具有良好的镇痛和镇静作用,且能有效降低5-HT、hs-CRP水平,安全性较好。     

盐酸氢吗啡酮对晚期乳腺癌患者的镇痛效果及疼痛相关激素水平研究

目的探讨盐酸氢吗啡酮对晚期乳腺癌患者的镇痛效果及血清疼痛相关激素水平的变化。方法将66例常规进行抗癌治疗的晚期乳腺癌癌痛患者按信封法随机分为研究组和对照组,各33例,研究组采用盐酸氢吗啡酮静脉镇痛泵治疗,对照组采用帕米磷酸二钠静脉镇痛泵治疗。分别于治疗前和治疗28d进行VAS评分和KPS评分,测定治疗前、治疗1、2、4个月的血清5-羟色胺（5-HT）、一氧化氮（NO）、前列腺素E2（PGE2）、皮质醇（Cor）、生长激素（GH）、泌乳素（PRL）等应激激素水平,并分析其血清疼痛介质及应激激素水平与其癌痛治疗效果以及KPS评分改善效果的关系。结果研究组VAS评分和KPS评分等级显著优于对照组,差异均有统计学意义（均P＜0.05）。与治疗前比较,两组治疗1、2、4个月的血清疼痛介质及应激激素水平均降低（均P＜0.05）。与对照组比较,研究组治疗1、2、4个月的激素水平均降低（均P＜0.05）。Spearman分析结果显示,晚期乳腺癌癌痛患者血清5-HT、NO、PGE2、Cor、GH、PRL水平与其癌痛治疗有效率和KPS评分均呈负相关（均P＜0.05）。结论盐酸氢吗啡酮静脉镇痛泵给药镇痛效果优于传统镇痛药物,其机制可能和盐酸氢吗啡酮对疼痛反应相关激素水平抑制作用更强有关。     

丙美卡因复合氢吗啡酮对七氟醚全麻斜视手术患儿苏醒期躁动的影响

目的 探讨丙美卡因复合氢吗啡酮对七氟醚全麻斜视手术患儿苏醒期躁动的安全性和有效性。方法 选取枣庄市妇幼保健院麻醉科2018年6月～2019年5月七氟醚全麻下斜视矫正术的患儿120例,按照随机数字表法分为两组:丙美卡因组(Ⅰ组)60例,麻醉诱导后应用丙美卡因;丙美卡因复合氢吗啡酮组(Ⅱ组)60例,麻醉诱导后给予丙美卡因和氢吗啡酮。比较两组麻醉时间、手术时间、清醒时间、拔除喉罩时间、出PACU时间、苏醒期躁动评分、躁动发生率、恶心呕吐、低氧、呛咳、嗜睡等发生情况。结果 Ⅱ组麻醉时间、手术时间、清醒时间、拔除喉罩管时间、出PACU时间与Ⅰ组比较,差异无统计学意义(P0.05)。Ⅱ组苏醒期躁动评分及躁动发生率均低于Ⅰ组,差异有统计学意义(P0.05);Ⅱ组麻醉苏醒期呛咳不良反应发生率低于Ⅰ组,差异有统计学意义(P0.05);Ⅱ组恶心呕吐、低氧、嗜睡等不良反应发生情况与Ⅰ组比较,差异无统计学意义(P0.05)。结论 丙美卡因复合氢吗啡酮用于七氟醚全麻斜视手术患儿可明显有效降低苏醒期躁动评分及躁动发生率,安全性好,值得临床进一步推广。