氢吗啡酮复合曲马多在结核性脓胸患者术后静脉自控镇痛中的应用效果

doi:10.3969/j.issn.1671-7171.2024.09.027

摘要
图/表
参考文献
相关文章 (15)

全文: PDF (1217 KB) HTML (1 KB)
输出: BibTeX | EndNote (RIS) 背景资料

摘要【目的】探讨氢吗啡酮复合曲马多在结核性脓胸患者术后静脉自控镇痛(PCIA)中的应用效果。【方法】104例结核性脓胸患者,随机分为对照组与观察组,每组52例。术后,对照组采用曲马多行PCIA,观察组采用氢吗啡酮复合曲马多行PCIA。比较两组患者术后不同时间的镇痛效果、呼吸循环指标及认知功能,术前、术后18 h应激指标[皮质醇(Cor)、C反应蛋白(CRP)]及不良反应发生情况。【结果】两组患者术后6 h、18 h、24 h的视觉模拟评分法(VAS)评分较术后3 h均升高(P<0.05),术后18 h的VAS评分较术后6 h均升高(P<0.05),术后24 h的VAS评分较术后18 h均降低(P<0.05);观察组术后6 h、18 h及24 h的VAS评分均低于对照组(P<0.05)。两组患者术后CRP、Cor水平较术前均升高,但观察组低于对照组(P<0.05)。术后12 h,观察组心率(HR)、呼吸频率(RR)低于对照组,血氧饱和度(SpO₂)高于对照组(P<0.05)。与术前比较,两组术后18 h的蒙特利尔认知评估量表(MoCA)评分均降低(P<0.05),但观察组高于对照组(P<0.05);与术后18 h比较,两组术后24 h的MoCA评分均升高(P<0.05);两组术前、术后24 h MoCA评分比较,差异无统计学意义(P>0.05);观察组不良反应总发生率低于对照组(P<0.05)。【结论】氢吗啡酮复合曲马多应用于结核性脓胸患者术后镇痛中,有利于缓解患者的疼痛感,减少对认知功能的影响,改善应激指标,降低不良反应的发生率。

	服务

	把本文推荐给朋友
	加入我的书架
	加入引用管理器
	E-mail Alert
	RSS
	作者相关文章
	叶霞
	王璐

关键词 ：脓胸, 结核性/外科学, 氢吗啡酮/治疗应用, 曲马多/治疗应用, 镇痛

Abstract：【Objective】To explore the effect of hydromorphone combined with tramadol on postoperative intravenous patient-controlled analgesia (PCIA) in patients with tuberculous empyema.【Methods】A total of 104 patients with tuberculous empyema were randomly divided into the control and the observation groups, with 52 cases in each group. Postoperatively, the control group received tramadol for PCIA, while the observation group received hydromorphone combined with tramadol for PCIA. The postoperative analgesic effect, respiratory and circulatory indicators, and cognitive function at different time points were compared between the two groups. Stress indicators [cortisol (Cor), C-reactive protein (CRP)] before and 18 h after surgery and the incidence of adverse reactions were also compared.【Results】The visual analog scale (VAS) pain scores at 6 h, 18 h, and 24 h postoperatively were higher than those at 3 h postoperatively in both groups (P<0.05). In both groups, the VAS scores at 18 h postoperatively were higher than those at 6 h postoperatively (P<0.05), while the VAS scores at 24 h postoperatively were lower than those at 18 h postoperatively (P<0.05). Compared to the control group, the VAS scores at 6 h, 18 h, and 24 h postoperatively were lower in the observation group (P<0.05). The postoperative CRP and Cor levels were higher than the preoperative levels in both groups, with the observation group showing lower levels than the control group (P<0.05). At 12 h postoperatively, the heart rate (HR) and respiratory rate (RR) were lower, and the oxygen saturation (SpO₂) was higher in the observation group compared to the control group (P<0.05). Compared to preoperative levels, the Montreal Cognitive Assessment (MoCA) scores at 18 h postoperatively were lower in both groups (P<0.05), while the score of MoCA in the observation group was higher than that in the control group (P<0.05). Compared to MOCA scores at 18 h postoperatively, the MoCA scores at 24 h postoperatively were higher in both groups (P<0.05). There was no statistically significant difference in the MoCA scores between preoperative and 24 h postoperatively in both groups (P>0.05). The total incidence of adverse reactions was lower in the observation group, compared to the control group (P<0.05). 【Conclusion】The application of hydromorphone combined with tramadol for postoperative analgesia in patients with tuberculous empyema helps alleviate pain, reduces the impact on cognitive function, improves stress indicators, and reduces the incidence of adverse reactions.

Key words： Empyema, Tuberculous/SU Hydromorphone/TU Tramadol/TU Analgesia

收稿日期: 2023-06-15

中图分类号:

R655.6

通讯作者: * E-mail:844358192@qq.com

引用本文:

叶霞, 王璐. 氢吗啡酮复合曲马多在结核性脓胸患者术后静脉自控镇痛中的应用效果[J]. 医学临床研究, 2024, 41(9): 1378-1381.
YE Xia, WANG Lu. Effect of Hydromorphone Combined with Tramadol on Postoperative Intravenous Patient-Controlled Analgesia in Patients with Tuberculous Empyema. JOURNAL OF CLINICAL RESEARCH, 2024, 41(9): 1378-1381.

链接本文:

http://journal07.magtech.org.cn/yxlcyj/CN/10.3969/j.issn.1671-7171.2024.09.027 或 http://journal07.magtech.org.cn/yxlcyj/CN/Y2024/V41/I9/1378

[1] SUN W W, YIN G D, CAI H M. The efficacy and safety of uniportal video-assisted thoracic surgery on the treatment for stage Ⅱ-Ⅲ tuberculous empyema:a single-arm clinical retrospective study from 2016 to 2021 in a thoracic surgery center in China[J].BMC Pulmonary Med,2022, 22(1):74.
[2] FANG Y, CHENG L P, GUO J. Application of endobronchial ultrasound-guided transbronchial needle aspiration in the diagnosis and treatment of mediastinal lymph node tuberculous abscess:a case report and literature review[J].J Card Sur,2020, 15(1):724.
[3] ZHAO P, MEI L S, WANG W Z.Clinical study of ultrasound-guided methylene blue thoracic paravertebral nerve block for the treatment of postherpetic neuralgia[J].Turk Neurosurg,2019, 29(6):811-815.
[4] 刘松华, 方懿, 曹理言. 超声引导下胸椎旁神经阻滞对结核性脓胸手术患者麻醉复苏室内复苏质量的影响[J].中国医师杂志, 2021, 23(1):10-14.
[5] 孟志明,李煜,杨贺林. 盐酸氢吗啡酮复合曲马多在剖宫产术后静脉自控镇痛的临床观察[J].北方药学,2024,21(2):175-177.
[6] 中华医学会, 中华医学会杂志社, 中华医学会全科医学分会, 等.肺结核基层诊疗指南(2018年)[J].中华全科医师杂志, 2019, 18(8):709-717.
[7] 任航空, 李楠楠, 宋栓宝.双侧局限性结核性脓胸Ⅰ期手术临床疗效分析[J].中国热带医学, 2019, 19(3):271-275.
[8] YANG H Y, DONG Q L, LIANG L X, et al.The comparison of ultrasound-guided thoracic paravertebral blockade and internal intercostal nerve block for non-intubated video-assisted thoracic surgery[J].J Thorac Dis,2019, 11(8):3476-3481.
[9] 华兵. 盐酸曲马多、地佐辛、舒芬太尼、盐酸氢吗啡酮防治瑞芬太尼复合麻醉术后超敏痛的效果比较[J].中国当代医药,2018,25(2):115-118.
[10] 杨志军, 黄佳洋, 熊浪, 等. 氢吗啡酮联合地佐辛麻醉对胸膜炎患者术后镇痛效果及对炎症因子水平的影响[J].空军医学杂志, 2019, 35(3):246-249.
[11] 罗雪梅, 丁黎, 潘寅兵, 等. 人血浆中氢吗啡酮的LC-MS测定方法及其应用[J].药学与临床研究, 2019, 20(4):304-307.
[12] 燕琳, 张传汉. 氢吗啡酮的药理作用及临床研究进展[J].中国疼痛医学杂志, 2015,2(9):701-703.
[13] 崔秀雯, 刘岳鑫, 张英. 氢吗啡酮对心脏病患者的心肌保护作用研究[J].中国现代医学杂志, 2019, 29(6):65-68.
[14] 蔡哲, 曾祥灵, 顾祥阳. 氢吗啡酮替代吗啡改善术后镇痛的效能[J].中山大学学报(医学科学版), 2019, 37(4):579-584.