目的 探討加速康復外科(ERAS)下硬膜外鹽酸嗎啡注射液復合鹽酸丁丙諾啡注射液用于胸腔鏡術后多模式鎮(zhèn)痛。方法 選取2019年10月-2022年10月邯鄲市中心醫(yī)院行胸腔鏡手術100例患者,將所有患者隨機分為對照組和治療組,每組各50例。所有患者進行ERAS干預。對照組患者硬膜外鹽酸嗎啡注射液體復合注射用帕瑞昔布鈉,治療組患者硬膜外鹽酸嗎啡注射液復合鹽酸丁丙諾啡注射液。鎮(zhèn)痛至術后72 h。比較兩組鎮(zhèn)痛效果、炎癥反應、鎮(zhèn)痛泵使用和不良反應情況。結果 術后4、24、48、72 h兩組靜息和活動時VAS評分均明顯降低(P<0.05);治療組術后4、24、48、72 h靜息和活動時VAS評分明顯低于對照組(P<0.05)。術后72 h,兩組血清白細胞介素-6(IL-6)、C反應蛋白(CRP)、腫瘤壞死因子-α(TNF-α)水平均明顯下降(P<0.05),且治療組血清IL-6、CRP、TNF-α水平明顯低于對照組(P<0.05)。治療組鎮(zhèn)痛泵按壓次數(shù)、嗎啡累積使用量明顯低于對照組(P<0.05)。治療組的不良反應發(fā)生率明顯低于對照組(P<0.05)。結論 ERAS下硬膜外鹽酸嗎啡注射液復合鹽酸丁丙諾啡注射液對胸腔鏡手術后具有良好的鎮(zhèn)痛作用,能夠改善炎癥反應,降低鎮(zhèn)痛泵按壓次數(shù)和嗎啡累積使用量,且具有良好的安全性。

Objective To discuss multimodal analgesia after thoracoscopic surgery of epidural Morphine Hydrochloride Injection combined with Buprenorphine Hydrochloride Injection in enhanced recovery after surgery (ERAS). Methods Patients (100 cases) underwent thoracoscopic surgery at Handan Central Hospital from October 2019 to October 2022 were selected, and were randomly divided into control group and treatment group, and each group had 50 cases. All patients underwent ERAS intervention. The control group patients received epidural injection of Morphine Hydrochloride Injection combined with Parecoxib Sodium for injection, while the treatment group patients received epidural injection of Morphine Hydrochloride Injection combined with Buprenorphine Hydrochloride Injection. Analgesia continued until 72 h after surgery. Analgesic efficacy, inflammatory reactions, use of analgesic pumps, and adverse reactions were compared between two groups. Results The VAS scores at rest and activity in both groups at 4, 24, 48, and 72 h after surgery were significantly decreased (P < 0.05), and these in the treatment group were significantly lower than those in the control group (P < 0.05). Serum levels of IL-6, CRP, and TNF-α in both groups were significantly decreased at 72 h after surgery (P < 0.05), and these in the treatment group were significantly lower than those of the control group (P < 0.05). The number of compressions of the analgesic pump and the cumulative use of morphine in the treatment group were significantly lower than those in the control group (P < 0.05). The incidence of adverse reactions in the treatment group was significantly lower than that in the control group (P < 0.05). Conclusion Under ERAS, epidural Morphine Hydrochloride Injection combined with Buprenorphine Hydrochloride Injection has a good analgesic efficacy after thoracoscopic surgery, which can alleviate the inflammatory response, reduce the number of analgesic pump presses and the cumulative use of morphine with higher safety.

R971

河北省2020年度醫(yī)學科學研究課題計劃(20202479)