氢吗啡酮和吗啡对子宫全切术后镇痛镇静的比较

目的探讨吗啡和氢吗啡酮在腹部手术后镇痛、镇静的效果和副作用。方法择期全麻下行全子宫切除术患者60例，年龄50—60岁，体重50～65kg，ASA分级Ⅰ～Ⅱ级，采用随机数字表法，将其分为吗啡组（M组）和氢吗啡酮组（H组）（n=30）。术中持续泵注瑞芬太尼0．2μg／min·kg，异丙酚0．2mg／min·kg，间断推注阿曲库铵，手术结束前1h推注舒芬太尼0．2μg/kg预防反跳痛，缝皮时开始全凭静脉自控镇痛（PCIA）。吗啡组（M组）0．7mg／kg加生理盐水稀释至100ml。氢吗啡酮组（H组）0．12mg／kg加生理盐水稀释至100ml。两组自控镇痛泵设置：持续输注2ml／h，自控给药量2ml／次，锁定时间30min，极限量6ml／h。记录两组患者48h内VAS镇痛评分、Ramsay镇静评分和其他副作用。结果术后8、16、24h，H组的VAS镇痛评分明显低于M组（P〈0．05），H组的Ramsay镇静评分明显高于M组（P〈0．05）。H组发生恶心3例，皮肤瘙痒2例；M组患者发生恶心5例，皮肤瘙痒3例。结论氢吗啡酮在临床中对腹部手术患者术后镇痛效果优于吗啡组，镇静效果强于吗啡组，其余不良反应无明显差异。

Comparison of Analgesic and Sedative Effects between Hydromorphone and Morphine in Total Hysterectomy

Objective To compare the effectiveness and side effects of morphine and hydromorphone after abdominal surgery. Methods 60 patients undergoing total hysterectomy with ASA Ⅰ or Ⅱ were randomly divided into hydromorphone group （group H, n = 30）and morphine group （group M, n = 30 ）. 0. 2μg/min · kg of remifentanil and 0.2 mg/min · kg of propofol pumped continuously with atraeurium intermittently. 0.2μg/kg of sufentanil was injected 1 hour before the end of surgery to prevent rebound tenderness. Patient -controlled intravenous analgesia（PCIA） started at the time of suturing skin. 0.7 mg/kg of morphine was diluted to 100 ml in normal saline in group M. 0.12 mg/ kg of hydromorphone was diluted to 100 ml in normal saline in group H. 2 ml/h of continuous injection dosage,2 ml every time,30 min of locking time,6 ml/h of maximum dose were setted. VAS scores,Ramsay scores and adverse reactions were recorded in 48 h. Results VAS scores at 8,16, and 24 h after surgery were lower in group H than those in group M（P 〈 0.05 ）. Ramsay scores were higher in group H than that in group M （P 〈 0.05 ）. 3 patients with nausea and 2 patients with skin pruritus occurred in group H. 5 patients with nausea and 3 patients with skin pruritus occurred in group M. Conclusion Analgesic and sedative effects of hydromorphone are better than morphine. There is no significant difference in adverse reactions between the two groups.