氢吗啡酮在房颤心脏射频消融术中的应用
Application of hydromorphone in radiofrequency ablation of atrial fibrillation

目的:探讨氢吗啡酮用于房颤心脏射频消融术的效果。方法:选择行心脏射频消融术的房颤患者60例,分为芬太尼组(30例)和氢吗啡酮组(30例)。在房间隔穿刺成功后,芬太尼组给予芬太尼1 μg/kg静脉注射,随后以1 μg/(kg？h)持续泵注维持; 氢吗啡酮组给予氢吗啡酮1 mg静脉注射。比较两组患者入手术室(T0)、手术开始(T1)、射频消融(T2)、手术结束(T3)时的血压和血氧饱和度(SpO2),消融时VAS评分和Ramsay评分,以及术后麻醉相关不良反应发生情况。结果:两组患者T1、T2、T3时平均动脉压(MAP)均较T0时升高,T2时SpO2降低(P<0.05); 氢吗啡酮组MAP较芬太尼组降低(P<0.05)。与芬太尼组比较,氢吗啡酮组消融时VAS评分较低,Ramsay评分较高(P<0.05),补救药物使用率较低,麻醉满意率较高(P<0.05)。两组患者呼吸抑制、头晕、恶心、呕吐、口干、便秘的发生率差异无统计学意义(P>0.05)。结论:氢吗啡酮可以有效缓解房颤患者心脏射频消融术中的疼痛,安全性良好。
Aim: To observe the analgesic effect and safety of hydromorphone in patients with atrial fibrillation during radiofrequency ablation.Methods: A total of 60 patients with atrial fibrillation undergoing cardiac radiofrequency ablation were divided into fentanyl group(30 cases)and hydromorphone group(30 cases). After atrial septal puncture, fentanyl group received intravenous injection of 1 μg/kg fentanyl, followed by 1 μg/(kg？h)continuous infusion to maintain, hydromorphone group was given intravenous injection of 1 mg hydromorphone. The blood pressure and SpO2 between the two groups when entering the operation room(T0), at the beginning of the operation(T1), radiofrequency ablation(T2), at the end of operation(T3), were compared.VAS and Ramsay score at radiofrequency ablation and the occurrence of postoperative anesthesia complications were recorded.Results: Compared with T0, MAP significantly increased at T1, T2 and T3 in the two groups.MAP of hydromorphone group was lower than that of fentanyl group(P<0.05). SpO2 at T2 was lower than the other time points in the two groups(P<0.05). Compared with those of fentanyl group, VAS score was significantly lower and Ramsay score was higher in hydromorphone group at radiofrequency ablation(P<0.05), rescue medication use rate was lower, and the satisfaction to anesthesia was higher(P<0.05). The incidences of respiratory depression, dizziness, nausea, vomiting, dry mouth, or constipation between the two groups had no statistical differences(P>0.05).Conclusion: Hydromorphone could effectively relieve the pain of patients undergoing radiofrequency ablation, and is safe