高血压患者下肢骨手术后三种镇痛方法对血流动力学的影响

    The hemodynamic influence of three analgesia methods on hypertensive patients undergoing osteal surgery

    • 摘要: 目的: 比较高血压患者下肢骨手术后三种镇痛方法对患者血流动力学的影响。方法: 选择45例ASAⅡ-Ⅲ级,行下肢骨手术的高血压患者,随机均分为三组(n=15)。连续硬膜外镇痛组(E组):负荷量吗啡2 mg,镇痛药液为吗啡0.08 mg/kg+0.75%布比卡因150 mg+氟哌利多2 mg。连续静脉镇痛组(I组):负荷量曲马多100 mg,镇痛药液为芬太尼0.012 mg/kg+曲马多400 mg+氟哌利多2 mg,均用生理盐水稀释至100 ml。背景输注速度2 ml/h。哌替啶镇痛组(D组):遵医嘱必要时肌肉注射哌替啶2 mg/kg。术后行视觉模拟评分法(VAS)评分,观察有效按压次数、不良反应,比较术后1 h、4 h、8 h、12 h、24 h及48 h的收缩压、舒张压、心率和脉搏血氧饱和度。结果: E、I两组镇痛效果好,差异无统计学意义(P>0.05)。D组镇痛效果差。三组间,E组血流动力学平稳,I组次之,D组不平稳(P<0.01)。结论: 高血压患者下肢骨术后采取连续硬膜外镇痛安全、有效,有利于维持血流动力学稳定。

       

      Abstract: Objective: To compare the effects of three analgesia methods on the hemodynamic of hypertensive patients receiving the lower limb bone surgery.Methods: Forty-five hypertensive patients with ASA,Ⅱ-Ⅲ undergoing lower limb bone surgery were randomly divided into 3 groups(n=15).Epidural analgesia group(group E)were administered loading dose of morphine 2 mg,morphine 0.08 mg/kg+0.75% bupivacaine 150 mg+droperidol 2 mg;intravenous analgesia group(group I)received loading dose of tramadol 100 mg,fentanyl 0.012 mg/kg+tramadol 400 mg+droperidol 2 mg;Pethidine analgesia group(group D)were given intramuscular injection of pethidine 100 mg when necessary.The visual analogue scales,adverse effects,and SBP,DBP,HR,etc.were recorded at the time point of 0,1,4,8,12,24 and 48 hour after operation.Results: Group E and I didn't show any significant difference in the analgesic effects(P>0.05).The hemodynamic response of group E was the most stable in the 3 groups and the second was group I;the hemodynamic response of group D wasn't stable(P<0.01).Conclusions: For the hypertensive patients receiving lower limb bone surgery,PCEA is safe and effective,and ND can keep the stability of their hemodynamic responses.

       

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