标题：氢吗啡酮预处理在冠心病患者骨科手术中的超前镇痛效果及对患者心功能的影响

      作者：殷俊茹，喻倩，陶蕾，杨永慧，卫白杨，牛江涛    中国人民解放军空军军医大学第二附属医院麻醉科，陕西 西安 710038

      卷次： 2022年33卷8期

      【摘要】 目的 探究氢吗啡酮预处理在冠心病患者骨科手术中的超前镇痛效果及对患者心功能的影响。方法 选取 2019年 1月至 2021年 1月中国人民解放军空军军医大学第二附属医院收治的 150例全身麻醉下行骨折手术的冠心病患者，采用随机数表法将其分为观察组和对照组各75例。麻醉诱导前10 min，观察组患者予以氢吗啡酮肌内注射2 mL，对照组患者予以肌内注射等量的生理盐水，两组患者其他麻醉方法均相同。比较两组患者麻醉前(T0)、切皮10 min时(T1)、拔管前(T2)及拔管后(T3)的心率(HR)及平均动脉压(MAP)变化；比较两组患者术前1 h、术后2 h及6 h的血液相关指标[血清磷酸肌酸激酶同工酶(CK-MB)、肌红蛋白、血浆皮质醇(COR)、C反应蛋白(CRP)]水平；比较两组患者的麻醉苏醒时间、麻醉苏醒期间的躁动发生率及躁动评分[Ricker镇静-躁动评分(SAS)]；比较两组患者术后 2 h、6 h、12 h、24 h及48 h的疼痛状态[(视觉模拟评分(VAS)]。结果 两组患者T0时的HR及MAP比较差异均无统计学意义(P>0.05)，观察组患者T1、T2及T3时的HR、MAP明显低于对照组，差异均有统计学意义(P<0.05)，且两组内不同时间点的上述指标比较差异均有统计学意义(P<0.05)；两组患者术前1 h的血清CK-MB、肌红蛋白、COR及CRP水平比较差异均无统计学意义(P均>0.05)，术后2 h、6 h，两组患者的上述指标较术前1 h均明显升高，且对照组明显高于观察组，差异均有统计学意义(P<0.05)；两组患者的麻醉苏醒时间比较差异无统计学意义(P>0.05)，而观察组患者的麻醉苏醒期间的躁动发生率及SAS评分明显低于对照组，差异均有统计学意义(P<0.05)；两组患者术后2 h、6 h、12 h、24 h及48 h的VAS评分呈逐渐降低趋势，组内不同时间点比较差异均有统计学意义(P<0.05)，组间同一时间点比较差异也均有统计学意义(P<0.05)。结论 氢吗啡酮预处理对行骨科手术的冠心病患者有良好的镇痛、镇静效果，且可有效降低患者围术期的应激反应，保护心功能。
      【关键词】 冠心病；骨科手术；氢吗啡酮预处理；心率；麻醉躁动；疼痛
      【中图分类号】 R541.4 【文献标识码】 A 【文章编号】 1003—6350（2022）08—0997—05

Preemptive analgesic effect of hydromorphone pretreatment in orthopedic surgery of patients with coronaryheart disease and its influence on cardiac function.
YIN Jun-ru, YU Qian, TAO Lei, YANG Yong-hui, WEI Bai-yang,NIU Jiang-tao. Department of Anesthesiology, the Second Affiliated Hospital of Air Force Military Medical University ofChinese People’s Liberation Army, Xi’an 710038, Shaanxi, CHINA
【Abstract】 Objective To explore the preemptive analgesic effect of hydromorphone pretreatment in orthope-dic surgery of patients with coronary heart disease and its influence on cardiac function of patients. Methods A total of150 patients with coronary heart disease undergoing orthopedic surgery under general anesthesia treated in the SecondAffiliated Hospital of Air Force Military Medical University of Chinese People's Liberation Army were selected fromJanuary 2019 and January 2021. They were divided into an observation group and a control group according to the ran-dom number table method, with 75 patients in each group. At 10 min before induction of anesthesia, the observationgroup was given intramuscular injection of 2 mL of hydromorphone, and the control group was given intramuscular in-jection of the same amount of normal saline. Other anesthesia methods were the same in both groups. The changes inheart rate (HR) and mean arterial pressure (MAP) before anesthesia (T0), at 10 min after skin incision (T1), before extu-bation (T2) and after extubation (T3) were compared between the two groups. The levels of blood-related indicators [se-rum creatine kinase isoenzyme (CK-MB), myoglobin, plasma cortisol (COR), C-reactive protein (CRP)] at 1 h beforesurgery, 2 h and 6 h after surgery were compared between the two groups. The anesthesia recovery time, incidence rateof agitation during anesthesia recovery, and agitation score [Ricker Sedation-Agitation Score (SAS)] were also comparedbetween the two groups; pain status [Visual Analogue Scale (VAS)] at 2 h, 6 h, 12 h, 24 h and 48 h after surgery werecompared between the two groups. Results There were no statistically significant differences in HR and MAP betweenthe two groups at T0 (P>0.05); the HR and MAP of the observation group at T1, T2, and T3 were significantly lowerthan those of the control group (P<0.05); there were statistically significant differences in the above indicators at differ-