氢吗啡酮复合右美托咪定硬膜外注射对老年全髋关节置换术术后镇痛的效果

华君; 汤燕彬; 刘宇芳; 唐立飞; 廖兴志

doi:10.7619/jcmp.20210221

氢吗啡酮复合右美托咪定硬膜外注射对老年全髋关节置换术术后镇痛的效果

中国人民解放军联勤保障部队第九〇四医院麻醉科, 江苏无锡, 214000

基金项目:

2017年江苏省高层次卫生人才“六个一工程”拔尖人才项目 LGY2017008

江苏省无锡市科技局项目 T201825

详细信息

通讯作者:
廖兴志, E-mail: hhp5h5@163.com

中图分类号: R614.2;R61
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出版历程
- 收稿日期: 2021-02-02
- 网络出版日期: 2021-04-29
- 发布日期: 2021-04-27

Analgesic effect of epidural injection of hydromorphone combined with dexmedetomidine in elderly patients after total hip replacement

Department of Anesthesiology, The 904 Hospital of the Joint Logistic Support Force of People's Liberation Army, Wuxi, Jiangsu, 214000

摘要

摘要:
目的观察氢吗啡酮复合右美托咪定硬膜外注射对老年全髋关节置换术术后镇痛的效果。
方法将78例全髋关节置换术患者随机分为研究组和对照组，每组39例。对照组术毕硬膜外注射氢吗啡酮0.3 mg，研究组依次注射右美托咪定0.5 μg/kg及氢吗啡酮0.3 mg。2组术后均采用舒芬太尼静脉自控镇痛。比较2组术后1 h（T₁）、4 h（T₂）、12 h（T₃）、24 h（T₄）视觉模拟评分法（VAS）评分、Ramsay镇静评分、心率（HR）、平均动脉压（MAP）及血氧饱和度（SpO₂），记录舒芬太尼消耗量及不良反应的发生情况。
结果研究组静息和运动状态下T₃、T₄时点的VAS评分及Ramsay评分均低于对照组，差异有统计学意义（P < 0.05）；研究组T₄时点Ramsay评分低于T₁，差异有统计学意义（P < 0.05）。研究组T₂~T₄时点HR及T₁~T₃时点MAP低于对照组，差异有统计学意义（P < 0.05）；研究组T₂~T₄时点HR低于T₁时点，对照组T₂~T₄时点MAP低于T₁时点，差异有统计学意义（P < 0.05）。研究组舒芬太尼消耗量少于对照组，差异有统计学意义（P < 0.05）。2组不良反应比较，差异无统计学意义（P>0.05）。
结论氢吗啡酮复合右美托咪定硬膜外注射对老年全髋关节置换术后镇痛效果显著，可稳定血流动力学指标，利于术后恢复。
- 右美托咪定 /
- 全髋关节置换术 /
- 氢吗啡酮 /
- 血流动力学
Abstract:
Objective To observe the analgesic effect of epidural injection of hydromorphone combined with dexmedetomidine in elderly patients after total hip arthroplasty.
Methods Seventy-eight patients undergoing total hip arthroplasty were randomly divided into study group and control group, with 39 cases in each group. The control group was given epidural injection of 0.3 mg hydromorphone after the operation, and the study group was sequentially injected with dexmedetomidine 0.5 μg/kg and hydromorphone 0.3 mg. Intravenous controlled analgesia by sufentanil was used in both groups. At 1, 4, 12, 24 h (T₁, T₂, T₃, T₄) after operation, Visual Analogue Scale(VAS) scores, Ramsay sedation score, heart rate (HR), mean arterial pressure (MAP) and blood oxygen saturation (SpO₂) of the two groups were compared. The sufentanil consumption dosage and adverse reactions were recorded.
Results The VAS scores and Ramsay scores at T₃ and T₄ of the study group were significantly lower than those of the control group at rest and exercise (P < 0.05). The Ramsay score at T₄ of the study group was significantly lower than that of T₁ (P < 0.05). HR at T₂ to T₄ and MAP at T₁ to T₃ in the study group were significantly lower than those in the control group (P < 0.05). Compared with T₁, the study group had decreased HR at T₂ to T₄, and the control group had decreased MAP at T₂ to T₄ (P < 0.05). The consumption of sufentanil in the study group was significantly less than that in the control group (P < 0.05). There was no difference in adverse reactions between the two groups (P>0.05).
Conclusion The epidural injection of hydromorphone combined with dexmedetomidine has a significant analgesic effect after total hip arthroplasty in the elderly, and has the functions of stabilizing hemodynamics and benefiting postoperative recovery.
- dexmedetomidine /
- total hip replacement /
- hydromorphone /
- hemodynamics

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表 1 2组静息与运动状态下不同时点VAS评分比较(x±s) 分

状态	组别	T₁	T₂	T₃	T₄
静息	研究组(n=39)	2.31±0.32	2.45±0.41	2.33±0.51^*	1.85±0.33^*#
	对照组(n=39)	2.47±0.55	2.67±0.65	2.58±0.47	2.01±0.26^#
运动	研究组(n=39)	2.77±0.51	2.98±0.45	2.51±0.74^*	2.03±0.22^*#
	对照组(n=39)	2.94±0.63	3.11±0.52	2.98±0.45	2.33±0.41^#
与对照组比较, *P < 0.05; 与T₁时点比较, #P < 0.05。

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表 2 2组不同时点Ramsay镇静评分比较(x±s) 分

组别	n	T₁	T₂	T₃	T₄
研究组	39	2.43±0.41	2.66±0.91	2.37±0.52^*	1.96±0.11^*#
对照组	39	2.57±0.32	2.83±0.51	2.62±0.43	2.21±0.38
与对照组比较, *P < 0.05; 与T₁比较, #P < 0.05。

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表 3 2组各时点HR、MAP、SpO₂比较(x±s)

指标	组别	T₁	T₂	T₃	T₄
心率/(次/min)	研究组	78.81±6.22	69.64±7.15^*#	68.35±7.74^*#	72.55±7.36^*#
	对照组	76.50±7.83	77.93±6.82	75.36±6.9	76.12±6.64
平均动脉压/mmHg	研究组	77.84±6.61^*	76.33±5.16^*	75.46±6.55^*	75.96±6.52
	对照组	81.63±5.12	79.01±4.25^#	77.98±5.15^#	75.59±5.30^#
血氧饱和度/%	研究组	98.86±0.81	99.04±0.91	99.12±0.89	99.01±0.95
	对照组	99.23±0.85	99.15±0.93	98.89±0.92	98.86±0.88
与对照组比较, *P < 0.05; 与T₁比较, #P < 0.05。

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表 4 2组24 h内舒芬太尼消耗量及PCIA首次使用时间比较(x±s)

组别	n	舒芬太尼消耗用量/μg	首次使用PCIA时间/min
研究组	39	46.71±9.55^*	8.75±8.32
对照组	39	51.22±10.03	6.83±7.24
PCIA: 患者自控静脉镇痛。与对照组比较, *P < 0.05。

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