目的: 探究氢吗啡酮超前镇痛对非长骨骨折手术患者血浆游离脂肪酸水平的影响。方法: 选取因锁骨骨折入包头市中心医院择期行全麻下切开复位钢板内固定术患者60例。随机分成两组,观察组患者在皮肤切口前15 min静脉缓慢注射氢吗啡酮30 μg/kg,对照组患者在皮肤切口前15 min静脉缓慢注射等量生理盐水。观察指标:入室安静5 min(T0),切皮时(T1),手术开始30 min(T2)、拔管后30 min(T5)时平均动脉压(MAP)、心率(HR);T0、T2、T5时刻血浆游离脂肪酸(FFA)、去甲肾上腺素(NE)、肾上腺素(E)水平;入室安静5 min(T0),拔管后5 min(T3),拔管后10 min(T4),拔管后30 min(T5)时刻的VAS评分;术后呼吸抑制、恶心呕吐、皮肤瘙痒和苏醒期躁动发生率。结果: 对照组和观察组患者的ASA分级、BMI、性别、年龄、身高、体重、VAS评分、MAP、HR和血浆NE、E、FFA水平在T0时组间比较差异无统计学意义(P＞0.05)。观察组患者MAP和HR在T1、T2、T5时刻均低于对照组(P＜0.05)。观察组患者血浆NE、E和FFA水平在T2、T5时刻均低于对照组(P＜0.05)。观察组患者VAS评分在T3、T4、T5时刻均低于对照组(P＜0.05)。恶心呕吐、皮肤瘙痒、呼吸抑制组间比较差异无统计学意义(P＞0.05);对照组苏醒期躁动发生率高于观察组 (P＜0.05)。结论: 在非长骨骨折手术中给予30 μg/kg氢吗啡酮超前镇痛可以有效降低术后疼痛,降低围术期应激,减少血流动力学波动,稳定血浆游离脂肪酸水平。同时有效减少苏醒期躁动且不增加术后呼吸抑制、皮肤瘙痒与恶心呕吐等不良反应的发生率。

Objective: To explore the effect of preemptive analgesia with hydromorphine on the level of plasma free fatty acids in patients with non-long bone fracture surgery. Methods: Sixty patients with clavicular fractures who were admitted to Baotou Central Hospital for elective open reduction and plate internal fixation under general anesthesia were selected. Randomized into two groups, patients in the observation group were were slowly injected with hydromorphone 30 μg / kg intravenously 15 min before the skin incision, while the patients in the control group were slowly injected with the same amount of normal saline intravenously 15 min before the skin incision. Observation indicators: mean arterial pressure (MAP) and heart rate (HR) at 5 min after entering the operating room (T0), skin incision (T1), 30 min after operation (T2) and 30 min after extubation (T5); the levels of plasma free fatty acid (FFA), norepinephrine (NE) and epinephrine (E) at T0, T2 and T5; VAS scores at 5 min (T0), 5 min (T3), 10 min (T4) and 30 min (T5) after extubation; the incidence of postoperative respiratory depression, nausea and vomiting, skin itching and emergence agitation. Results: There was no significant difference in ASA classification, BMI, gender, age, height, weight, VAS score, MAP, HR and plasma NE, E and FFA levels between the control group and the observation group at T0 (P＞0.05). The MAP and HR in the observation group were lower than those in the control group at T1, T2 and T5 (P＜0.05). The levels of plasma NE, E and FFA in the observation group were lower than those in the control group at T2 and T5 (P＜0.05). The VAS scores of the observation group were lower than those of the control group at T3, T4 and T5 (P＜0.05). There was no significant difference in the incidence of nausea and vomiting, skin itching and respiratory depression between the two groups (P＞0.05). The incidence of emergence agitation in the control group was higher than that in the observation group (P＜0.05). Conclusion: Preemptive analgesia with 30 μg/kg hydromorphone in non-long bone fracture surgery can effectively reduce postoperative pain, reduce perioperative stress and hemodynamic fluctuations, stabilize plasma free fatty acid levels. At the same time, it can effectively reduce the emergence agitation and does not increase the incidence of postoperative respiratory depression, skin itching, nausea and vomiting and other adverse reactions.