实用药物与临床
實用藥物與臨床
실용약물여림상
Practical Pharmacy and Clinical Remedies
2015年
9期
1062-1065
,共4页
氢吗啡酮%超前镇痛%苏醒期躁动%术后镇痛%镇静
氫嗎啡酮%超前鎮痛%囌醒期躁動%術後鎮痛%鎮靜
경마배동%초전진통%소성기조동%술후진통%진정
Hydromorphone%Preemptive analgesia%Emergence agitation%Postoperative analgesia%Sedation
目的 探讨氢吗啡酮静脉超前镇痛对全麻患者苏醒期躁动及术后镇痛的影响. 方法 择期全麻下行肺叶切除术患者40例,年龄55~64岁,体重指数18~24 kg/m2 ,ASAⅠ~Ⅱ级. 采用随机数字表法,将其随机分为2组. 对照组即术后全凭静脉镇痛组(A组),插管后皮下注射生理盐水2 mL;超前镇痛组(B组)患者插管后皮下注射氢吗啡酮2 mL (2 mg). 术中持续泵注瑞芬太尼0.2 μg/(min·kg),异丙酚0.2 mg/(min·kg),根据肌松情况术中间断推注苯磺酸顺式阿曲库铵0.1 mg/kg. 静脉镇痛泵用100 μg舒芬太尼加生理盐水稀释至100 mL,手术结束后开始全凭静脉自控镇痛( PCIA):首次剂量2 mL,持续输注2 mL/h,自控给药量1 mL/次,锁定时间30 min,极限量6 mL/h. 记录两组患者手术后呼吸恢复时间,拔管时间,拔管时心率、收缩压,躁动评分( RS) ,24 h内VAS镇痛评分、Ramsay镇静评分. 结果 两组患者的呼吸恢复、手术后拔管时间与Ramsay镇静评分比较差异无统计学意义(P>0.05). B组苏醒期心率、收缩压低于A组,躁动评分低于A组,两组比较差异有统计学意义(P<0.05). 术后1、2 h,B组的VAS评分低于A组(P<0.05),其余时间两组VAS评分比较差异无统计学意义(P>0.05). 结论 术前皮下注射氢吗啡酮可减轻全麻患者术后苏醒期躁动,血流动力学稳定,与对照组比较,镇静效果无明显差异,而术后2h内镇痛效果较好.
目的 探討氫嗎啡酮靜脈超前鎮痛對全痳患者囌醒期躁動及術後鎮痛的影響. 方法 擇期全痳下行肺葉切除術患者40例,年齡55~64歲,體重指數18~24 kg/m2 ,ASAⅠ~Ⅱ級. 採用隨機數字錶法,將其隨機分為2組. 對照組即術後全憑靜脈鎮痛組(A組),插管後皮下註射生理鹽水2 mL;超前鎮痛組(B組)患者插管後皮下註射氫嗎啡酮2 mL (2 mg). 術中持續泵註瑞芬太尼0.2 μg/(min·kg),異丙酚0.2 mg/(min·kg),根據肌鬆情況術中間斷推註苯磺痠順式阿麯庫銨0.1 mg/kg. 靜脈鎮痛泵用100 μg舒芬太尼加生理鹽水稀釋至100 mL,手術結束後開始全憑靜脈自控鎮痛( PCIA):首次劑量2 mL,持續輸註2 mL/h,自控給藥量1 mL/次,鎖定時間30 min,極限量6 mL/h. 記錄兩組患者手術後呼吸恢複時間,拔管時間,拔管時心率、收縮壓,躁動評分( RS) ,24 h內VAS鎮痛評分、Ramsay鎮靜評分. 結果 兩組患者的呼吸恢複、手術後拔管時間與Ramsay鎮靜評分比較差異無統計學意義(P>0.05). B組囌醒期心率、收縮壓低于A組,躁動評分低于A組,兩組比較差異有統計學意義(P<0.05). 術後1、2 h,B組的VAS評分低于A組(P<0.05),其餘時間兩組VAS評分比較差異無統計學意義(P>0.05). 結論 術前皮下註射氫嗎啡酮可減輕全痳患者術後囌醒期躁動,血流動力學穩定,與對照組比較,鎮靜效果無明顯差異,而術後2h內鎮痛效果較好.
목적 탐토경마배동정맥초전진통대전마환자소성기조동급술후진통적영향. 방법 택기전마하행폐협절제술환자40례,년령55~64세,체중지수18~24 kg/m2 ,ASAⅠ~Ⅱ급. 채용수궤수자표법,장기수궤분위2조. 대조조즉술후전빙정맥진통조(A조),삽관후피하주사생리염수2 mL;초전진통조(B조)환자삽관후피하주사경마배동2 mL (2 mg). 술중지속빙주서분태니0.2 μg/(min·kg),이병분0.2 mg/(min·kg),근거기송정황술중간단추주분광산순식아곡고안0.1 mg/kg. 정맥진통빙용100 μg서분태니가생리염수희석지100 mL,수술결속후개시전빙정맥자공진통( PCIA):수차제량2 mL,지속수주2 mL/h,자공급약량1 mL/차,쇄정시간30 min,겁한량6 mL/h. 기록량조환자수술후호흡회복시간,발관시간,발관시심솔、수축압,조동평분( RS) ,24 h내VAS진통평분、Ramsay진정평분. 결과 량조환자적호흡회복、수술후발관시간여Ramsay진정평분비교차이무통계학의의(P>0.05). B조소성기심솔、수축압저우A조,조동평분저우A조,량조비교차이유통계학의의(P<0.05). 술후1、2 h,B조적VAS평분저우A조(P<0.05),기여시간량조VAS평분비교차이무통계학의의(P>0.05). 결론 술전피하주사경마배동가감경전마환자술후소성기조동,혈류동역학은정,여대조조비교,진정효과무명현차이,이술후2h내진통효과교호.
Objective To evaluate the preemptive analgesia effects of hydromorphone on emergence agitation and postoperative analgesia in patients with general anesthesia. Methods Forty ASAⅠorⅡpatients aged 55~64 years old with BMI 18~24 kg/m2 undergoing pulmonary lobectomy were randomly divided into 2 groups:Patient controlled intraveneous analgesia ( PCIA) group ( group A) was given subcutaneous injection of normal saline 2 mL after intuba-tion,hydromorphone group (group B) was given subcutaneous injection of hydromorphone 2 mL (2 mg) after intuba-tion. Remifentanil was injected with micro perfusion pump by 0.2 μg/( min·kg) ,propofol was injected with micro per-fusion pump by 0.2 mg/( min·kg) ,cisatracurium was injected discontinuously. After operation,PCIA started:100 μg sufentanil was diluted in normal saline (100 mL). The first dose of injection was 2 mL with continuous injection dos-age of 2 mL/h,the controlled dosage by patients was 1 mL per time,the locking time was 30 min,and limited dose was 6 mL/h. The time of postoperative respiratory recovery and extubation,systemic blood pressure and heart rate after ex-tubation,agitation scores, Ramsay scores and VAS with in 24 h were recorded. Results There was no significant difference in the postoperative respiratory recovery time,extubation time and Ramsay scores between the two groups ( P>0.05). The heart rate,systemic blood pressure and agitation score after extubation in group B were lower than those of group A (P<0.05). The VAS scores of group B were lower than those of group A at 1,2 h after operation (P<0.05). Conclusion Preemptive analgesia with hydromorphone can improve the emergence agitation of patients with general anesthesia,the hemodynamics is stable with better analgesia effect within 2 h after operation ( compared with control group) ,and has good sedation effect.
