盐酸氢吗啡酮超前镇痛对全身麻醉腔镜手术患者的作用
Effect of preemptive analgesia with hydromorphone hydrochloride in patients un-dergoing endoscopic surgery under general anesthesia
石小龙 1张宏鑫 1薛华燕 1闫振弘 1宋禹强 1马平康 1章云飞2
作者信息
- 1. 黄河三门峡医院麻醉科,三门峡 472000
- 2. 河南省肿瘤医院麻醉与围手术期医学科,郑州 450000
- 折叠
摘要
目的 探讨盐酸氢吗啡酮超前镇痛对全身麻醉腔镜手术患者的镇痛效果.方法 选取行腹腔镜胆囊切除术的患者98例,用随机数字表法分为对照组和观察组,各49例.对照组实施常规麻醉,观察组在对照组常规麻醉的基础上予以盐酸氢吗啡酮超前镇痛.记录2组患者的拔管时间、清醒时间和自主呼吸恢复时间,分别于患者手术结束时(t1)、手术后1 h(t2)、手术后4 h(t3)、手术后12 h(t4)和手术后24 h(t5),用视觉模拟评分(visual analogue scale,VAS)对患者阵痛效果进行评分;于t0、t1和t2检测血清肿瘤坏死因子-α(tumor necrosis factor-α)、白细胞介素-10(interleukin-10,IL-10)和白细胞介素-6(interleukin-6,IL-6)水平,于t0和t1检测患者肾素、血管紧张素Ⅱ、醛固酮和皮质醇水平,并记录患者不良反应的发生情况.结果 与t0相比,t1、t2、t3和t4时间点2组患者的VAS评分均升高,且观察组低于对照组(P＜0.05);t1和t2时间点2组患者TNF-α、IL-10和IL-6水平均较t0时升高,且观察组TNF-α和IL-6水平更低,IL-10水平更高(P＜0.05);t1时2组患者肾素、血管紧张素Ⅱ、醛固酮和皮质醇水平较t0均升高,且观察组低于对照组(P＜0.05).2组患者围手术期指标和不良反应发生情况比较,差异无统计学意义.结论 盐酸氢吗啡酮超前镇痛可减少全身麻醉腔镜手术患者术后躁动,缓解应激反应,减轻炎性反应,具有较好的镇痛效果.
Abstract
Objective To investigate the analgesic effect of hydromorphone hydrochloride preemptive analgesia in patients undergoing endoscopic surgery under general anesthesia.Methods A total of 98 patients undergoing laparoscopic cholecystectomy were selected and divided into control group and observation group by random number table method,with 49 cases in each group.The control group was given conventional anesthesia,and the observation group was given preemptive analgesia with hydromorphone hydrochloride on the basis of the control group.Record the extubation time,awake time and spontaneous breathing recovery time of the 2 groups of pa-tients,at the end of surgery(t1),1 hour(t2),4 hours(t3),12 hours(t4)and 24 hours(t5)after surgery,respectively.The visual analogue scale(VAS)was used to score the pain effect of the patients,and the serum tumor necrosis factor-α(TNF-α),interleukin-10(IL-10)and interleukin-6(IL-6)levels,renin,angiotensin Ⅱ,aldosterone and cortisol levels were detected at t0 and t1,and ad-verse reactions were recorded.Results Compared with t0,the VAS scores of patients in each group at time points t1,t2,t3 and t4 were all higher than those at t0,and the observation group were lower than the control group(P＜0.05).The levels of TNF-α,IL-10 and IL-6 in the 2 groups at t1 and t2 time points were higher than those at t0,and the levels of TNF-α and IL-6 in the observation group were lower and the levels of IL-10 were higher(P＜0.05).At t1,the levels of renin,angiotensin Ⅱ,aldosterone and cortisol in the 2 groups were higher than those at t0,and the observation group was lower than the control group(P＜0.05).There was no significant difference in perioperative indicators and adverse reactions between the 2 groups(P＞0.05).Conclusion Hydromorphone hydrochlo-ride preemptive analgesia can reduce postoperative agitation in patients undergoing general anesthesia endoscopic surgery,relieve stress response,reduce inflammatory response,and has a good analgesic effect.
关键词
盐酸氢吗啡酮/超前镇痛/腹腔镜胆囊切除术/镇痛效果/炎症Key words
hydromorphone hydrochloride/preemptive analgesia/laparoscopic cholecystectomy/analgesic effect/inflammation引用本文复制引用
基金项目
省级科技攻关计划(第二批)(2016)(162102310335)
出版年
2024
NETL
NSTL
维普
万方数据