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| 鞘内注射吗啡对胸腔镜肺叶切除术患者术后疼痛和恢复质量的影响 |
| Effects of intrathecal morphine on postoperative pain and the quality of postoperative recovery in patients undergoing thoracoscopic lobectomy |
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| DOI：10.12089/jca.2023.03.011 |
| 中文关键词: 吗啡 术后疼痛 胸腔镜手术 肺切除术 恢复质量 |
| 英文关键词: Morphine Analgesia Thoracoscopy Pneumonectomy Quality of recovery |
| 基金项目:扬州市科技局社会发展计划（YZ2022109） |
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| 中文摘要: |
目的 评价鞘内注射吗啡对胸腔镜肺叶切除术患者术后疼痛和恢复质量的影响。
方法 选择择期行全麻下胸腔镜肺叶切除术患者90例，男39例，女51例，年龄18～64岁，BMI 18～30 kg/m 2，ASA Ⅰ或Ⅱ级。采用随机数字表法分为三组：吗啡联合无背景剂量镇痛泵组（QA组）、吗啡联合有背景剂量镇痛泵组（QB组）和对照组（C组），每组30例。QA组和QB组于术前在L2-3间隙单次注射吗啡5 μg/kg，术后QA组连接无背景剂量静脉镇痛泵（PCIA），QB组连接1 ml/h背景剂量的PCIA，C组仅在术后连接1 ml/h背景剂量的PCIA。记录术中瑞芬太尼用量、血管活性药使用率、术后48 h PCIA有效按压次数、术后舒芬太尼用量和补救镇痛情况。记录术后1、3、6、12、24、48、72 h静息和活动时疼痛数字评分（NRS评分），在术后1～2 d评估患者恢复指标和康复质量评分量表（QoR-15）。记录术后呼吸抑制、恶心呕吐、尿潴留、皮肤瘙痒等相关并发症的发生率。
结果 与C组比较，QA组术后舒芬太尼用量明显减少，QA和QB组术后48 h PCIA有效按压次数和补救镇痛率明显减少，术后3 h QB组活动时NRS评分明显降低，术后6、12、24、48和72 h QA组和QB组静息和活动NRS评分明显降低（P＜0.05）。三组术后拔管时间、首次进食时间和下床时间差异无统计学意义。与C组比较，术后1和2 d QA组和QB组QoR-15量表中疼痛、身体舒适度、心理支持、情绪状态四项评分和总分均明显升高（P＜0.05）。三组呼吸抑制、恶心呕吐、尿潴留和皮肤瘙痒的发生率差异无统计学意义。
结论 术前鞘内注射吗啡5 μg/kg可明显改善胸腔镜肺叶切除术患者术后72 h的急性疼痛，促进患者术后恢复。 |
| 英文摘要: |
Ojective To evaluate the effect of intrathecal morphine injection on postoperative pain and the quality of postoperative recovery in patients undergoing thoracoscopic lobectomy.
Methods Ninety patients undergoing for elective thoracoscopic lobectomy, 39 males and 51 females,aged 18-64 years, BMI 18-30 kg/m 2, ASA physical status Ⅰ or Ⅱ, were divided into three groups using a random number table method: intrathecal morphine combined with no background dose analgesic pump group (group QA), intrathecal morphine combined with background dose analgesic pump group (group QB), and control group(group C), 30 patients in each group. Group QA and group QB were given a single injection of morphine 5 μg/kg in the lumbar 2-3 space before surgery. Group QA was connected to an intravenous analgesia pump (PCIA) after surgery without a background dose and group QB was connected to PCIA with 1 ml/h background dose. Group C was only connected to PCIA with 1 ml/h background dose after surgery. The intraoperative remifentanil dosage, vasoactive drug utilization rate, times of effective pressing of analgesic pump within 48 hours after operation, the postoperative sufentanil dosage and the needs for rescue analgesia were recorded. Numeric rating scales (NRS) scores at rest and during movement were recorded at 1, 3, 6, 12, 24, 48, and 72 hours after operation. Within 1-2 days after the operation, the recovery indicators and the 15-item quality of recovery questionnaire (QoR-15) were evaluated. The incidence of postoperative respiratory depression, nausea and vomiting, urinary retention, skin itch and other related complications were recorded.
Results Compared with group C, the postoperative sufentanil dosage in group QA was reduced, and the times of effective PCIA compressions and rescue analgesia rate in groups QA and QB 48 hours after operation were significantly reduced, the NRS scores of group QB during movement decreased significantly 3 hours after operation, and the NRS scores of group QA and group QB at rest and during movement decreased significantly 6, 12, 24, 48, and 72 hours after operation(P < 0.05).There were no significant differences in postoperative extubation time, first feeding time and getting out of bed time among the three groups. Compared with group C, the scores of pain, physical comfort, psychological support, and emotional state and the total score of the QoR-15 scale in group QA and group QB were significantly increased 1, 2 days after surgery (P < 0.05). There was no significant difference in the incidence of respiratory depression, nausea and vomiting, urinary retention and skin pruritus among the three groups.
Conclusion Preoperative intrathecal injection of morphine 5 μg/kg can significantly improve postoperative acute pain within 72 hours after thoracoscopic lobectomy, promote recovery. |
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