Department of Anesthesiology, Xiangyang No. 1 People's Hospital, Hubei University of Medicine, Xiangyang, China.
Eur Rev Med Pharmacol Sci. 2018 Sep;22(17):5697-5703. doi: 10.26355/eurrev_201809_15837.
To observe the effects of hydromorphone and morphine intravenous analgesia on plasma motilin and postoperative nausea and vomiting in patients undergoing a total hysterectomy.
80 patients who underwent hysterectomy from April 2015 to June 2016 were randomly divided into two groups, with 40 patients in each group. The two groups received an intravenous infusion of hydromorphone or morphine for analgesia. The VAS pain score and Ramsey sedation score were recorded 4, 8, 12, 24, and 48 hours after the first dose of analgesia. The scores of nausea and vomiting were recorded. The levels of motilin were determined by radioimmunoassay before anesthesia, after anesthesia, during hysterectomy and 1 day after the operation. The results showed that the analgesic effect of hydromorphone was more rapid than morphine.
There were significant differences in VAS scores between the two groups at each time point (p<0.05), indicating that the analgesic effect of hydromorphone was better than morphine's one. The scores of Ramsay sedation were less than 6 points at each time point within 48 hours after the operation. The content of plasma motilin in the hydromorphone group was higher than that in the morphine group during the first day after anesthesia. There were 34 cases (85%) of mild nausea and vomiting within 24 hours after the operation in the hydromorphone group. In the morphine group, there were 16 cases (40%) of mild nausea and vomiting within 24 hours after the operation, 10 cases (25%) of severe nausea and vomiting.
The occurrence of severe malignant vomiting after the use of morphine was more than that after the use of hydromorphone. Normal level and function of motilin is the basis of avoiding nausea and vomiting. Too fast or too slow gastrointestinal motility can induce postoperative nausea and vomiting.
观察氢吗啡酮与吗啡静脉镇痛对全子宫切除术后患者血浆胃动素及术后恶心呕吐的影响。
选择 2015 年 4 月至 2016 年 6 月择期行全子宫切除术患者 80 例，随机分为两组，每组 40 例。两组均采用氢吗啡酮或吗啡静脉镇痛。记录术后 4、8、12、24、48 h 的视觉模拟评分（VAS）及 Ramsay 镇静评分，记录恶心呕吐评分。采用放射免疫法测定麻醉前、麻醉后、子宫切除时及术后第 1 天的血浆胃动素水平。结果：两组各时间点 VAS 评分比较差异均有统计学意义（P<0.05），提示氢吗啡酮的镇痛效果优于吗啡。两组术后 48 h 内 Ramsay 镇静评分均<6 分。氢吗啡酮组术后第 1 天血浆胃动素水平高于吗啡组。氢吗啡酮组术后 24 h 内恶心呕吐发生率为 34 例（85%），吗啡组为 16 例（40%），其中氢吗啡酮组轻度 34 例，重度 0 例；吗啡组轻度 16 例，重度 10 例。
吗啡组术后恶心呕吐发生率高于氢吗啡酮组。胃动素正常水平和功能是避免恶心呕吐的基础。胃肠动力过快或过慢均可诱发术后恶心呕吐。
