不同剂量氢吗啡酮用于膝关节置换术后硬膜外镇痛的临床观察

目的探讨不同预充剂量盐酸氢吗啡酮用于老年患者膝关节置换术后硬膜外自控镇痛的效果，观察不良反应情况，为临床用药提供参考遥方法选择在腰硬联合麻醉下行膝关节置换术的老年患者90 例，采用随机数字表法将其分为三组（H1 组尧H2 组及H3），每组30 例遥手术在腰硬联合麻醉下完成，术毕行PCEA遥手术结束前15 min 硬膜外给予负荷剂量，分别为盐酸氢吗啡酮H1 组0.1 mg尧H2 组0.2 mg尧H3 组0.3 mg，术毕连接镇痛泵，配方均为院氢吗啡酮1 mg+0.1%盐酸罗哌卡因+生理盐水至100 ml，背景输注速度2 ml/h，自控1 ml/次，锁定时间15 min遥观察并记录术后个时间点患者的平均动脉压尧心率尧氧饱和度，镇痛尧镇静评分及PCEA 按压次数，记录患者不良反应发生情况遥结果H2尧H3 组2 h尧4 h尧6 hVAS 评分明显低于H1 组，同时H1 组观察到PCA 的按压次数明显高于其他两组，差异有统计学意义（约0.05），H2 组与H3 组2 h尧4 h尧6 hVAS 评分无明显差异，无统计学意义（跃0.05）遥恶心呕吐和皮肤瘙痒发生的例数H3 组高于H1尧H2 组遥结论硬膜外注入0.2 mg 氢吗啡酮提供完善的镇痛的同时，恶心尧呕吐尧皮肤瘙痒等不良反应发生率低，可安全用于老年患者膝关节置换术后硬膜外镇痛遥

Clinical Observation of Epidural Analgesia after Knee Arthroplasty with Different Doses ofHydromorphine

Abstract:Objective To investigate the effects of different priming doses of hydromorphone hydrochloride for epidural analgesia inelderly patients after total knee arthroplasty,observe the adverse reaction conditions,to provide reference for clinical medication.Methods 90 elderly patients with lumbar epidural anesthesia for knee arthroplasty were randomly divided into three groups(groupH1,group H2 and H3),30 cases in each group.The surgery under combined spinal epidural anesthesia,postoperative PCEA.15 minbefore the end of surgery epidural administration of loading dose of hydromorphone hydrochloride,respectively in group H1,0.1 Mg,0.2mg H2 group,0.3 mg H3 group,postoperative analgesia pump,the formulations were: hydromorphone 1 mg +0.1% ropivacainehydrochloride +saline to 100 ml,background infusion speed 2 ml/h,controlled 1 ml/time,locking time 15 min. The mean arterialpressure,heart rate,oxygen saturation,analgesia,sedation score and the number of PCEA compression were observed and recorded atdifferent time points after operation.The incidence of adverse reactions in patients was recorded.Results The scores of 2 h, 4 h and 6hVAS in H2 and H3 groups were significantly lower than those in H1 group.The number of PCA compression in H1 group wassignificantly higher than that in the other two groups,the difference was statistically significant( <0.05),H2 group and H3 group,2h,4h,6 hVAS score had no significant difference,no statistical significance ( >0.05).The number of cases of nausea and vomiting in groupH3 and the occurrence of pruritus was higher than H1,H2 group. Conclusion Epidural hydromorphone provides perfect 0.2mg thepain,nausea,vomiting, skin itching and other adverse reaction rate is low,is safe for elderly patients with knee arthroplasty afterepidural analgesia.