Objective:To observe the prevention effects of PCIA with hydromorphone on the post-operative chro-nic pain in patients undergoing radical breast cancer surgery.Methods:The data of 90 ASAⅠorⅡwomen patients, aged 33~62 years old,with a body mass index of 18~24 kg/m2,undergoing elective radical surgery for breast canc-er,were randomly divided into 2 groups(45 cases),each group give PCIA after surgery with different analgesia drugs:Group F,fentanyl 25 μg/kg+azasetron 10 mg,group H:hydromorphone 0.25 mg/kg+azasetron 10 mg.PCIA drug solution was diluted to 100 ml with normal saline.The PCIA setting was as follows:Background infusion 1.5 ml/h,bo-lus dose 2 ml and lockout interval 15 min.The NRS score were evaluate at 1 h,4 h,12 h,24 h and 48 h after opera-tion.The side effects and PCIA pressing times within 48 h were recorded.The chronic pain syndrome within 2 months was evaluated.Results:There was no significantly difference in NRS score and Ramsay score between two groups at 1 h,4 h,12 h,24 h and 48 h after operation(P>0.05).Compared with group F,the incidence rate of nausea and vomi-ting,excessive sedation in group H were significantly decreased within 48 h(P<0.05).The incidence rate of chronic pain in group H were significantly lower than in group F(P<0.05).Conclusion:PCIA with hydromorphone had e-quivalent effects with fentanyl in analgesia on patients undergoing radical surgery for breast cancer,and have fewer side effects.Besides,hydromorphone was likely to decrease the post-mastectomy pain syndrome.%目的:观察氢吗啡酮静脉自控镇痛(PCIA)对乳腺癌术后慢性疼痛的预防效果.方法:选择90例择期行乳腺癌改良根治术的女性患者,年龄33~62岁,ASA Ⅰ或Ⅱ级,体重指数18~24 kg/m2.将患者随机分为2组(n=45),术后给予不同静脉自控镇痛:F组,芬太尼25 μg/kg+阿扎司琼10 mg;H组,盐酸氢吗啡酮0.25 mg/kg+阿扎司琼10 mg.镇痛泵容量100 ml,背景输注速率1.5 ml/h,单次按压给药量2 ml,锁定时间15 min.采用数字评分量表法(NRS)评估术后1 h、4 h、12 h、24 h、48 h时疼痛评分、Ramsay镇静评分、48 h内不良反应情况、PCIA按压次数;评估术后2个月内慢性疼痛发生情况.结果:在术后1~48 h期间,两组NRS评分和Ramsay镇静评分比较差异无统计学意义(P>0.05);H组过度镇静和恶心呕吐发生率明显低于F组(P<0.05);在术后2个月内,H组术后慢性疼痛发生率明显低于F组(P<0.05).结论:氢吗啡酮术后静脉自控镇痛能够达到芬太尼的镇痛效果,不良反应发生率较低,可能降低乳腺癌术后慢性疼痛的发生率.
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