氢吗啡酮超前镇痛在老年肩关节镜手术患者中的应用

目的 探讨氢吗啡酮超前镇痛对老年肩关节镜手术患者围术期疼痛程度、血流动力学及应激反 应的影响。方法 选取2022年1月-12月于泰州市人民医院择期行全麻下单侧肩关节镜手术患者90例作为研 究对象。根据随机数字表法分为观察组和对照组，每组45例。观察组麻醉诱导前10 min静脉注射氢吗啡 酮，对照组静脉注射等体积的生理盐水，之后均行常规气管插管全麻，手术结束后送入PACU复苏，统 一术后镇痛方案，比较两组不同时间点麻醉诱导前（T0）、插管即刻（T1）、手术切皮时（T2）、手 术结束时（T3）、气管拔管时（T4）、出麻醉复苏室时（T5）、术后4h（T6）、术后8h（T7）、术后 24h（T8）]围术期血流动力学平均动脉压（MAP）、心率（HR）]、VAS评分、应激指标去甲肾上腺素 （NE）、肾上腺素（E）、皮质醇（Cor）、血糖（Glu）水平]。结果 观察组T1~T5时间点MAP及HR 低于对照组，T5~T8时间点VAS评分低于对照组，T2及T3时间点Glu和血清NE、E及Cor含量低于对照 组（P＜0.05）。结论 氢吗啡酮超前镇痛可有效减轻老年肩关节镜手术患者围术期疼痛程度、降低围术期 应激反应及血流动力学波动，值得临床应用。

Application of Hydromorphone Preemptive Analgesia in Elderly Patients Undergoing Shoulder Arthroscopic Surgery

Objective To investigate the effect of hydromorphone preemptive analgesia on perioperative pain, hemodynamics and stress response in elderly patients undergoing shoulder arthroscopic surgery. Methods A total of 90 patients undergoing unilateral shoulder arthroscopic surgery under general anesthesia in Taizhou People''s Hospital from January to December 2022 were selected as subjects. According to the random number table method were divided into observation group and control group, with 45 cases in each group. The observation group was intravenously injected with hydromorphone 10 min before anesthesia induction, and the control group was intravenously injected with an equal volume of normal saline. After that, all patients underwent routine tracheal intubation general anesthesia. After the operation, they were sent to PACU for resuscitation and unified postoperative analgesia. The perioperative hemodynamics mean arterial pressure (MAP), heart rate (HR)], VAS score and stress index norepinephrine (NE), epinephrine (E), cortisol (Cor), blood glucose (Glu)] were compared between the two groups at different time points before anesthesia induction (T0), immediately after intubation (T1), at the time of skin incision (T2), at the end of operation (T3), at the time of tracheal extubation (T4), at the time of leaving the anesthesia recovery room (T5), 4 h after operation (T6), 8 h after operation (T7), 24 h after operation (T8)]. Results MAP and HR at T1-T5 time points in the observation group were lower than those in the control group, VAS score at T5-T8 time points was lower than that in the control group, Glu and serum NE, E and Cor contents at T2 and T3 time points were lower than those in the control group (P<0.05). Conclusion Hydromorphone preemptive analgesia can effectively reduce perioperative pain, perioperative stress response and hemodynamic fluctuations in elderly patients undergoing shoulder arthroscopic surgery, which is worthy of clinical application.