氢吗啡酮静脉自控镇痛对乳腺癌术后慢性疼痛的预防效果

目的:观察氢吗啡酮静脉自控镇痛（PCIA）对乳腺癌术后慢性疼痛的预防效果。方法:选择90例择期行乳腺癌改良根治术的女性患者，年龄33~62岁，ASA Ⅰ或Ⅱ级，体重指数18~24 kg/m2。将患者随机分为2组（n=45），术后给予不同静脉自控镇痛:F组，芬太尼25 μg/kg+阿扎司琼10 mg；H组，盐酸氢吗啡酮0.25 mg/kg+阿扎司琼10 mg。镇痛泵容量100 ml，背景输注速率1.5 ml/h，单次按压给药量2 ml，锁定时间15 min。采用数字评分量表法（NRS）评估术后1 h、4 h、12 h、24 h、48 h 时疼痛评分、Ramsay镇静评分、48 h内不良反应情况、PCIA按压次数；评估术后2个月内慢性疼痛发生情况。结果:在术后1~48 h期间，两组NRS评分和Ramsay镇静评分比较差异无统计学意义（P>0.05）；H组过度镇静和恶心呕吐发生率明显低于F组（P＜0.05）；在术后2个月内，H组术后慢性疼痛发生率明显低于F组（P＜0.05）。结论:氢吗啡酮术后静脉自控镇痛能够达到芬太尼的镇痛效果，不良反应发生率较低，可能降低乳腺癌术后慢性疼痛的发生率。

Preventive effects of PCIA with hydromorphone on the post-operative chronic pain in patients undergoing radical breast cancer surgery

Objective:To observe the prevention effects of PCIA with hydromorphone on the post-operative chronic pain in patients undergoing radical breast cancer surgery.Methods:The data of 90 ASA Ⅰ or Ⅱ women patients，aged 33~62 years old，with a body mass index of 18~24 kg/m2，undergoing elective radical surgery for breast cancer，were randomly divided into 2 groups(45 cases)，each group give PCIA after surgery with different analgesia drugs:Group F，fentanyl 25 μg/kg+azasetron 10 mg，group H:hydromorphone 0.25 mg/kg+azasetron 10 mg.PCIA drug solution was diluted to 100 ml with normal saline.The PCIA setting was as follows:Background infusion 1.5 ml/h，bolus dose 2 ml and lockout interval 15 min.The NRS score were evaluate at 1 h，4 h，12 h，24 h and 48 h after operation.The side effects and PCIA pressing times within 48 h were recorded.The chronic pain syndrome within 2 months was evaluated.Results:There was no significantly difference in NRS score and Ramsay score between two groups at 1 h，4 h，12 h，24 h and 48 h after operation(P>0.05).Compared with group F，the incidence rate of nausea and vomiting，excessive sedation in group H were significantly decreased within 48 h(P＜0.05).The incidence rate of chronic pain in group H were significantly lower than in group F(P＜0.05).Conclusion:PCIA with hydromorphone had equivalent effects with fentanyl in analgesia on patients undergoing radical surgery for breast cancer，and have fewer side effects.Besides，hydromorphone was likely to decrease the post-mastectomy pain syndrome.