目的: 评价氢吗啡酮超前镇痛用于胸腔镜肺叶切除术的效果及对患者术后快速康复的影响。方法: 取2021年11月-2022年11月本院择期行胸腔镜肺叶切除术手术患者60例,随机分为2组,每组30例即对照组、ERAS组,于手术切皮时、手术结束前30 min分别静注0.9 %生理盐水5 mL、15 μg/kg氢吗啡酮。收集两组患者入室后5 min(T1)、手术切皮时(T2)、拔除气管导管后30 min(T3)、拔管后6 h(T4)、拔管后72 h(T5)的平均动脉压(MAP);T1、T4时刻血清P物质(SP)、神经肽Y(NPY)、前列腺素E2(PGE2)浓度;管后30 min(T3)、6 h(T4)、72 h(T5)的VAS镇痛评分;两组手术后住院时间(LOS)。结果: (1)两组患者性别、年龄、BMI、手术时长、术中出血量、ASA分级差异无统计学意义(P＞0.05)。(2)ERAS组T1、T2、T3、T4时刻MAP差异无统计学意义(P＞0.05),对照组T4时刻MAP较T1、T2、T3、T5时刻均高,T5时刻MAP较T1时刻高,差异有统计学意义(P＜0.05);对照组在T2、T3、T4、T5时刻的MAP均高于ERAS组,差异有统计学意义(P＜0.05);对照组、ERAS组在T1时刻的血清SP、NPY、PGE2浓度差异无统计学意义(P＞0.05);对照组、ERAS组T4时刻的血清SP、NPY、PGE2浓度均较T1高,差异有统计学意义(P＜0.05);T4时刻对照组血清SP、NPY、PGE2浓度均高于ERAS组,差异有统计学意义(P＜0.05);ERAS组患者T3、T4、T5时刻VAS评分差异无统计学意义(P＞0.05),对照组患者T4时刻VAS评分较T3、T5时刻高,差异有统计学意义(P＜0.05);对照组在T3、T4、T5时刻的VAS评分均高于ERAS组,差异有统计学意义(P＜0.05);对照组、ERAS组患者LOS差异有统计学意义(P＜0.05)。结论: 胸腔镜肺叶切除术分别于手术切皮时、手术结束前30 min静注15 μg/kg氢吗啡酮能保障血流动力学平稳和有效术后镇痛,减轻炎症反应,还能减少术后住院时间,从而节约医疗成本、节省住院费用、增强生活质量。

Objective: To evaluate the effect of preemptive analgesia with hydromorphone in thoracoscopic lobectomy and its effect on the rapid recovery of patients after surgery. Methods: From November 2021 to November 2022, 60 patients undergoing thoracoscopic lobectomy in our hospital were randomly divided into two groups, with 30 patients in each group, namely the control group and the ERAS group, 0.9 % normal saline 5 mL and 15 μg/kg hydromorphone were injected intravenously at the time of skin incision and 30 min before the end of operation, respectively. The mean arterial pressure (MAP) of the two groups at 5 min after entering the operating room (T1), at the time of skin incision (T2), 30 min after extubation (T3), 6 h after extubation (T4) and 72 h after extubation (T5); serum concentrations of substance P (SP), neuropeptide Y (NPY) and prostaglandin E2 (PGE2) were measured at T1 and T4; the VAS pain scores at 30 min (T3), 6 h (T4) and 72 h (T5) after intubation; the postoperative length of stay (LOS) of the two groups was compared. Results: (1)There were no significant differences between the two groups in genders, ages, BMI, operation duration, intraoperative bleeding and ASA grades (P＞0.05). (2)There were no statistically significant differences in MAP at T1, T2, T3, T4 and T5 in ERAS group (P＞0.05), while the MAP at T4 in control group was higher than those at T1, T2, T3 and T5, and the MAP at T5 were higher than that at T1, the difference was statistically significant (P＜0.05); the MAP of the control group at T2, T3, T4 and T5 was higher than that of the ERAS group, the difference was statistically significant (P＜0.05); there was no significant difference in concentrations of SP, NPY and PGE2 at T1 between the control group and ERAS group (P＞0.05); the concentrations of SP, NPY and PGE2 at T4 in control group and ERAS group were higher than those of T1, the difference was statistically significant (P＜0.05); the concentrations of SP, NPY and PGE2 at T4 in the control group were higher than those in the ERAS group, and the difference was statistically significant (P＜0.05); there were no statistically significant differences in VAS scores at T3, T4 and T5 in ERAS group (P＞0.05), while the VAS scores at T4 in control group were higher than those at T3 and T5 (P＜0.05); the VAS scores at T3, T4 and T5 in the control group were significantly higher than those of the ERAS group (P＜0.05); There was a statistically significant difference in LOS between the control group and the ERAS group (P＜0.05). Conclusion: Intravenous injection of 15 ug/kg hydromorphone before and 30 minutes before the operation of thoracoscopic lobectomy can ensure hemodynamic stability and effective postoperative analgesia, reduce inflammatory reaction, and also reduce postoperative hospital stay, thus saving medical costs, hospital expenses and improving quality of life.