氢吗啡酮与芬太尼用于硬膜外镇痛和麻醉的比较

Hydromorphone vs fentanyl for epidural analgesia and anesthesia.

作者信息

Nguyen Melissa N, Zimmerman Lisa Hall, Meloche Kathy, Dolman Heather S, Baylor Alfred E, Fuleihan Samir, Wilson Robert F, Tyburski James G

机构信息

Department of Pharmacy Services, Detroit Receiving Hospital, 4201 St. Antoine Blvd, UHC-1B, Detroit, MI 48201, USA.

出版信息

Am J Surg. 2016 Mar;211(3):565-70. doi: 10.1016/j.amjsurg.2015.12.003. Epub 2015 Dec 29.

DOI:10.1016/j.amjsurg.2015.12.003

PMID:26778766

Abstract

BACKGROUND

Epidural analgesia/anesthesia is used during surgery because it dramatically relieves pain and attenuates the stress response. Because limited data exist regarding the relative merits of hydromorphone (HM) and fentanyl (FENT), the objective was to determine which was more safe and effective.

METHODS

Prospective case-matched, observational study evaluated elective surgery patients: 30 HM and 60 FENT. Variables were measured perioperatively.

RESULTS

Of the 90 patients, mean age was 52 years; simplified acute physiology score was 26 ± 10; and American Society of Anesthesiologists score was 2.4 HM vs 2.7 FENT, P = .03. HM patients were more apt to be excessively sedated (16% HM vs 1% FENT, P = .007) and have poor mental unresponsiveness (6% HM vs 0% FENT, P = .04). The incidence of hypotension was not different, 76% HM vs 80% FENT, not significant.

CONCLUSIONS

In a closely case-matched population, FENT caused less excessive sedation and unresponsiveness. FENT patients had better intraoperative urine output and tended to have less repeated episodes of hypotension.

摘要

背景

硬膜外镇痛/麻醉在手术中被广泛应用，因为它能显著减轻疼痛并减弱应激反应。由于关于氢吗啡酮（HM）和芬太尼（FENT）相对优缺点的现有数据有限，本研究旨在确定哪种药物更安全有效。

方法

采用前瞻性病例匹配观察性研究，评估择期手术患者：30例使用HM，60例使用FENT。在围手术期测量各项变量。

结果

90例患者的平均年龄为52岁；简化急性生理学评分26±10；美国麻醉医师协会评分为2.4（HM组）对2.7（FENT组），P = 0.03。HM组患者更易出现过度镇静（16%对1%，P = 0.007）和精神反应迟钝（6%对0%，P = 0.04）。低血压发生率无差异，分别为76%（HM组）和80%（FENT组），无统计学意义。