Objective: To evaluate the safety and efficiency of patient-controlled intravenous analgesia (PCIA) using hydromorphone supplement with dexmedetomidine on patients undergoing transcatheter arterial chemoembolization. Methods: One hundred and eighty patients, age ranged from 40 to 65 years, body mass index from 18 to 25 kg/m(2,) ASA physical status Ⅱ-Ⅲ, who were scheduled for transcatheter arterial chemoembolization (TACE) under monitor anesthesia care (MAC) were randomly divided into 3 groups: hydromorphone group (H group), hydromorphone supplement with dexmedetomidine 1 μg/kg group (D1 group), hydromorphone supplement with dexmedetomidine 2 μg/kg group (D2 group), 60 patients in every group. All the groups of patients received PCIA pump, in the H group, the PCIA reagent was composed of 120 μg/kg hydromorphone and 5 mg tropisetron in 100 ml of normal saline. In comparison, PCIA regiment was composed of 120 μg/kg hydromorphone, 1 μg/kg dexmedetomidine and 5 mg tropisetron in 100 ml of normal saline in the D1 group, while 120 μg/kg hydromorphone, 2 μg/kg dexmedetomidine and 5 mg tropisetron in 100 ml of normal saline in the D2 group. The visual analogue scale (VAS) score, the observer's assessment of alertness/sedation scale (OAA/S) score, patients' satisfaction index, consumption of hydromorphone, the additional dose of morphine, the effective pressing times of PCIA and adverse reactions were recorded in detail at 0, 0.5, 1, 4, 12 and 24 hours after the patients underwent TACE. Results: The total consumptions of hydromorphone were (4.3±0.1), (4.1±0.1), and (3.8±0.1) mg in group H, D1, and D2, respectively, and the effective pressing times were 13±3, 6±2 and 2±1, the additional doses of morphine were (30±5), (15±3), and (3±1) mg, and adverse reaction rates were 45.0%, 28.3%, and 10.0%, respectively. The manifestations mentioned above in D2 group were significantly lower than those in group H and group D1 (P<0.05). Immediately and 5 min after embolization, at the end of surgery and 0.5, 1, 4, 12 and 24 h after surgery, the VAS scores in the D2 group were 1.9±0.2, 2.1±0.3, 1.8±0.4, 1.8±0.3, 1.7±0.3, 1.6±0.3, 1.3±0.2, 1.3±0.3, respectively, lower than those in group H and group D1 (P<0.05); The satisfaction index in D2 group at these times were 8.7±1.1, 8.9±0.8, 9.2±0.9, 9.0±0.7, 9.1±0.8, 9.0±0.6, 9.1±0.7, 9.2±0.9, respectively, higher than those in group H and group D1 (P<0.05). No breath depression happened in these three groups. Conclusion: The formula of hydromorphone combined with dexmedetomidine to patients undergoing TACE is greatly safe and efficient, with advantages in alleviating pain, reducing hydromorphone consumption and the incidence of adverse reaction of hydromorphone, and without breath depression.
目的： 评价盐酸氢吗啡酮联合右美托咪定用于经皮肝动脉化疗栓塞(TACE)患者静脉自控镇痛的安全性和有效性。 方法： 选择美国麻醉医师协会(ASA)分级Ⅱ～Ⅲ级择期行TACE的肝癌患者180例，采用随机数字表法随机分为3组，每组60例。均于术前通过静脉自控镇痛泵(PCIA)给予不同镇痛药物：H组：盐酸氢吗啡酮120 μg/kg＋托烷司琼5 mg＋生理盐水100 ml；D1组：盐酸氢吗啡酮120 μg/kg＋右美托咪定1 μg/kg ＋托烷司琼5 mg＋生理盐水100 ml；D2组：盐酸氢吗啡酮120 μg/kg＋右美托咪定2 μg/kg＋托烷司琼5 mg＋生理盐水100 ml。分别于栓塞即刻和栓塞后5 min、手术结束和术后0.5、1、4、12及24 h，对患者进行视觉模拟评分(VAS)、OAA/S镇静评分、患者满意度评分，记录盐酸氢吗啡酮消耗总量、吗啡补救总量、术后PCIA按压次数及不良反应发生情况。 结果： H组、D1组和D2组患者盐酸氢吗啡酮消耗总量分别为(4.3±0.1)、(4.1±0.1)和(3.8±0.1)mg，PCIA按压次数分别为(13±3)、(6±2)和(2±1)次，吗啡追加总量分别为(30±5)、(15±3)和(3±1)mg，不良反应发生率分别为45.0%、28.3%和10.0%，D2组均低于H组和D1组(均P<0.05)。栓塞即刻和栓塞后5 min、手术结束和术后0.5、1、4、12及24 h，D2组VAS评分分别为(1.9±0.2)、(2.1±0.3)、(1.8±0.4)、(1.8±0.3)、(1.7±0.3)、(1.6±0.3)、(1.3±0.2)和(1.3±0.3)分，均低于H组和D1组(均P<0.05)；D2组患者满意度分别为(8.7±1.1)、(8.9±0.8)、(9.2±0.9)、(9.0±0.7)、(9.1±0.8)、(9.0±0.6)、(9.1±0.7)和(9.2±0.9)分，均高于H组和D1组(均P<0.05)。各组患者均未发生过度镇静。 结论： 盐酸氢吗啡酮联合右美托咪定静脉自控镇痛可以减轻肝动脉化疗栓塞患者疼痛，减少阿片类药物的应用，降低阿片类药物引起的不良反应，且没有过度镇静，具有良好的安全性。.
Keywords: Dexmedetomidine; Hydromorphone; Patient-controlled intravenous analgesia; Transcatheter arterial chemoembolization; Untoward reaction.