盐酸氢吗啡酮单次静脉注射联合自控镇痛用于乳腺癌根治术的临床观察

目的 探讨盐酸氢吗啡酮单次静脉注射联合自控镇痛用于乳腺癌根治术的效果,为乳腺癌根治术后患者的镇痛治疗提供参考。方法 选择我院2017-01~2017-08收治的120例行乳腺癌根治术的患者作为研究对象,随机分为对照组和观察组,各60例。其中对照组手术结束前30min静注生理盐水4ml,观察组则静注盐酸氢吗啡酮0.4 mg,术后立即连接静脉镇痛泵(舒芬太尼150μg+氟比洛芬酯注射液150 mg+托烷司琼10 mg+生理盐水至100 mL)。分析两组患者的术前术后免疫功能变化情况,比较两组患者术后12 h、24 h、48 h的疼痛评分(VAS)、镇静评分(Ramsay)以及不良反应情况。结果 术后5d ,与对照组相比,观察组CD8⁺明显降低,CD4⁺、CD⁴+ /CD8⁺明显升高(P<0.05);与对照组相比,观察组不同时间点的镇静评分明显较高,镇痛评分明显较低,镇痛镇静效果较好(P<0.05);两组患者不良反应差异不显著(P>0.05)。结论 盐酸氢吗啡酮单次静脉注射联合自控镇痛可以显著增强镇痛、镇静效果,提高舒适度,增强术后免疫力,不良反应发生率低,安全有效,值得临床推广使用。

Clinical observation of single intravenous injection of morphine hydrochloride combined with controlled analgesia in radical mastectomy

Objective To investigate the effect of hydromorphone hydrochloride combined with intravenous control on analgesia in patients with breast cancer after radical operation, and to provide reference for analgesic treatment of patients after radical mastectomy. Methods We selected 120 patients treated by radical mastectomy from January 2017 to August 2017 as the subjects. They were randomly divided into observation group and control group, the 60 cases, which gave the control group of patients with intramuscular injection of hydromorphone hydrochloride, and observation group of patients given intravenous administration of morphine hydrochloride intravenous administration. The pain score (VAS), sedation score (Ramsay) of two groups of patients after 12h, 24h were compared and adverse reactions were analyzed. The changes of immune function were analyzed between the two groups after treatment. Results At 5 days after operation, compared with the control group, the CD8+ level in the observation group was significantly lower, and the CD4+ and CD4+/CD8+ levels were significantly higher (P<0.05). Compared with the control group, the sedation scores of the observation group at different time points were significantly higher and analgesia was observed. The scores were significantly lower, and the analgesic and sedative effects were better (P<0.05). There was no significant difference in adverse reactions between the two groups (P>0.05). Conclusion The combination of hydromorphone hydrochloride and intravenous administration can significantly enhance the analgesic effect, sedation effect, improve the comfort, enhance the postoperative immunity, the low incidence of adverse reactions, safe and effective, worthy of clinical use.