目的 探讨加速康复外科(ERAS)下硬膜外盐酸吗啡注射液复合盐酸丁丙诺啡注射液用于胸腔镜术后多模式镇痛。方法 选取2019年10月-2022年10月邯郸市中心医院行胸腔镜手术100例患者,将所有患者随机分为对照组和治疗组,每组各50例。所有患者进行ERAS干预。对照组患者硬膜外盐酸吗啡注射液体复合注射用帕瑞昔布钠,治疗组患者硬膜外盐酸吗啡注射液复合盐酸丁丙诺啡注射液。镇痛至术后72 h。比较两组镇痛效果、炎症反应、镇痛泵使用和不良反应情况。结果 术后4、24、48、72 h两组静息和活动时VAS评分均明显降低(P<0.05);治疗组术后4、24、48、72 h静息和活动时VAS评分明显低于对照组(P<0.05)。术后72 h,两组血清白细胞介素-6(IL-6)、C反应蛋白(CRP)、肿瘤坏死因子-α(TNF-α)水平均明显下降(P<0.05),且治疗组血清IL-6、CRP、TNF-α水平明显低于对照组(P<0.05)。治疗组镇痛泵按压次数、吗啡累积使用量明显低于对照组(P<0.05)。治疗组的不良反应发生率明显低于对照组(P<0.05)。结论 ERAS下硬膜外盐酸吗啡注射液复合盐酸丁丙诺啡注射液对胸腔镜手术后具有良好的镇痛作用,能够改善炎症反应,降低镇痛泵按压次数和吗啡累积使用量,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年度医学科学研究课题计划(20202479)