关节腔内注射盐酸氢吗啡酮在膝关节镜手术术后镇痛中的临床应用

目的 评价关节腔内注射不同剂量盐酸氢吗啡酮对膝关节镜手术术后镇痛的效果. 方法 择期硬膜外麻醉下行膝关节镜手术患者150例,按随机数字表法分为5组(每组30例):H1组、H2组、H3组、M组、C组.术毕H1组关节腔内注射盐酸氢吗啡酮0.1 mg(用生理盐水配制成10ml),H2组关节腔内注射盐酸氢吗啡酮0.2 mg,H3组关节腔内注射盐酸氢吗啡酮0.3 mg,M组关节腔内注射吗啡2 mg,C组关节腔内注射等量生理盐水10ml.记录术后4、6、8、12、24 h患者在屈膝关节90°状态下的VAS,记录术后24h内需要追加镇痛药物的患者例数以及术后副作用的发生情况. 结果 术后8h内H1组、H2组、H3组、M组VAS评分比较,差异无统计学意义(P＞0.05);术后12 h VAS评分,H2组(2.5±0.6)分、H3组(2.1±0.7)分、M组(2.3±0.8)分低于H1组(3.1±0.6)分,差异有统计学意义(P＜0.01);术后24 h VAS评分,H3组(2.2±0.5)分低于H2组(3.1±0.8)分和M组(3.0±0.6)分,差异有统计学意义(JP＜0.05).术后需要追加镇痛药物的患者例数随盐酸氢吗啡酮剂量的增加而减少.结论 关节腔内注射不同剂量盐酸氢吗啡酮和吗啡用于膝关节镜均能获得良好的术后镇痛效果,0.3 mg盐酸氢吗啡酮的镇痛效果更佳.

The clinical application of intra-articular injected hydromorphone in knee arthroscopy

Objective To evaluate the effects of intra-articular different dose hydromorphone injection for postoperative analgesia after knee arthroscopy.Methods One hundred and fifty patients scheduled for knee arthroscopy were randomly divided into five groups with 30 patients in each group,according to random number table.The group H1 was given hydromorphone 0.1 mg (make the volume to 10 ml with saline) intra-articular,and group H2 was 0.2 mg,group H3 was 0.3 mg,group M was given morphine 2 mg,group C was given 10 ml saline intra-articular.Analgesic efficacy was evaluated by VAS 4,6,8,12 h and 24 h after administration of different dose hydromorphone,morphine or placebo.The number of patients needing postoperative analgesic and the side effects were evaluated.Results The VAS scores of 24 h,group H1,group H2,group H3 and group M were significantly lower than group C (P＜0.01).Group H1,group H2,group H3 and group M were no significantly difference at 8 hafter operation.The VAS scores,(2.5±0.6) points in group H2,(2.1±0.7) points in group H3 and (2.3±0.8) points in group M were significantly lower than (3.1±0.6) points in group H1(P＜0.01) at 12 h after operation,and (2.2±0.5) points in group H3 was lower than (3.1±0.8) points in group H2 and (3.0±0.6) points in group M at 24 h after operation (P＜0.05).The number of patients needing postoperative analgesic was decreased with the dose of hydromorphone increased.Conclusions Compared with placebo,different dose intra-articular hydromorphone and morphine can provid a good analgesic effect after arthroscopic knee surgery,and 0.3 mg hydromorphone was the best.