Yan Guangming, Chen Jie, Yang Guiying, Duan Guangyou, Du Zhiyong, Yu Zubin, Peng Jing, Liao Wei, Li Hong
Department of Anesthesiology, Anesthesiology of Xinqiao Hospital of Third Military Medical University, Shapingba District, Chongqing, 400037, China.
Department of Anesthesiology, Xinqiao Hospital, Shapingba District, Thoracic Surgery of Xinqiao Hospital of Third Military Medical University, Chongqing, 400037, China.
BMC Anesthesiol. 2018 Dec 19;18(1):192. doi: 10.1186/s12871-018-0657-7.
To compare the analgesic effects of patient-controlled intravenous analgesia (PCA) with hydromorphone and sufentanil after thoracic surgery on postoperative pulmonary complications (PPCs).
A total of 142 patients who were scheduled for thoracic surgery were randomly allocated to receive PCA with hydromorphone (group A: experimental group): hydromorphone 0.2 mg/kg + dezocine 0.5 mg/kg + ramosetron 0.6 mg diluted with normal saline to 200 mL; or with sufentanil (group B: control group): sufentanil 3.0μg/kg + dezocine 0.5 mg/kg + ramosetron 0.6 mg diluted with normal saline to 200 mL. The parameters of intravenous analgesia pump were set as background dose 4 ml/h, PCA dose 1 mL, locking time 15 min. Pain NRS (numerical rating scale), Ramsay sedation score, nausea or vomiting score were evaluated at 0 h, 6 h, 12 h, 24 h, 48 h after operation. The cases of PPCs (atelectasis, pulmonary infection, respiratory failure), CRP (C-reaction protein) and inflammatory cells (white cell count and percentage of neutrophils) and blood gas analysis at 12 h after operation, length of ICU and postoperative stay were recorded for each patient.
Data of 136 patients were analyzed. Compared with group B (4[IQR:2,2]), the pain NRS in group A (2[IQR:4,4]) was significantly lower at 6 h after operation (P = 0.000). The CRP in group A (69.79 ± 32.13 mg/L) were lower than group B (76.76 ± 43.42 mg/L) after operation, but the difference was not significant (P = 0.427). No difference of nausea or vomiting was found between group A (7.3%) and group B (5.8%) postoperatively (P = 0.999). The PPCs were happened in 11 patients in group A (16.2%) and 22 patients in group B (32.4%) and the difference between two groups was significant (P = 0.027). Seven patients in group A (10.3%) and eighteen patients in group B (26.5%) had clinical evidence of pneumonia and the difference between two groups was significant (P = 0.014). The length of ICU and postoperative stay in group A were 2.73 h and 1.82 days less than group B respectively but the differences were not significant (P = 0.234, P = 0.186 respectively).
Compared with sufentanil, hydromorphone may provide better postoperative analgesic effect with less pulmonary complications for patients undergoing thoracic surgery, and it may accelerate patients' rehabilitation.
Randomized Controlled Trials ChiCTR1800014282c . Registered 3 January 2018.
比较胸科手术后患者自控静脉镇痛（PCA）中使用氢吗啡酮和舒芬太尼对术后肺部并发症（PPCs）的镇痛效果。
总共142例计划进行胸科手术的患者被随机分配接受氢吗啡酮PCA（A组：实验组）：氢吗啡酮0.2mg/kg + 地佐辛0.5mg/kg + 雷莫司琼0.6mg用生理盐水稀释至200mL；或舒芬太尼PCA（B组：对照组）：舒芬太尼3.0μg/kg + 地佐辛0.5mg/kg + 雷莫司琼0.6mg用生理盐水稀释至200mL。静脉镇痛泵参数设置为背景剂量4ml/h，PCA剂量1mL，锁定时间15分钟。术后0小时、6小时、12小时、24小时、48小时评估疼痛数字评分法（NRS）、Ramsay镇静评分、恶心或呕吐评分。记录每位患者术后12小时的PPCs（肺不张、肺部感染、呼吸衰竭）情况、C反应蛋白（CRP）、炎症细胞（白细胞计数及中性粒细胞百分比）以及血气分析结果、重症监护病房（ICU）时长和术后住院时间。
分析了136例患者的数据。与B组（4[四分位间距：2,2]）相比，A组术后6小时的疼痛NRS（2[四分位间距：4,4]）显著更低（P = 0.000）。术后A组的CRP（69.79±32.13mg/L）低于B组（76.76±43.42mg/L），但差异无统计学意义（P = 0.427）。术后A组（7.3%）和B组（5.8%）之间恶心或呕吐情况无差异（P = 0.999）。A组11例患者（16.2%）发生PPCs，B组22例患者（32.4%）发生PPCs，两组间差异有统计学意义（P = 0.027）。A组7例患者（10.3%）和B组18例患者（26.5%）有肺炎的临床证据，两组间差异有统计学意义（P = 0.014）。A组ICU时长和术后住院时间分别比B组少2.73小时和1.82天，但差异无统计学意义（分别为P = 0.234，P = 0.186）。
与舒芬太尼相比，氢吗啡酮可为胸科手术患者提供更好的术后镇痛效果，且肺部并发症更少，可能加速患者康复。
随机对照试验ChiCTR1800014282c。于2018年1月3日注册。
