吗啡和芬太尼用于心房颤动射频消融术中的镇痛效果研究

A Study of the Analgesic Effects of Morphine and Fentanyl for Radiofrequency Ablation of Atrial Fibrillation

摘要: 目的：探讨吗啡和芬太尼在心房颤动射频消融术中的镇痛效果。方法：纳入2020年9月~2021年5月就诊于青岛大学附属医院并行射频消融术的心房颤动患者共80例，随机分为2组，分别在射频消融前静脉缓慢给予吗啡和芬太尼，术后记录患者的疼痛视觉模拟评分(VAS)、Ramsay镇静评分，并观察患者在入室时(T0)、给药后(T1)、手术开始时(T2)、射频消融开始10 min后(T3)、射频消融结束10 min后(T4)的平均动脉压(MAP)、心率(HR)、血氧饱和度(SpO₂)，记录患者发生恶心、呕吐、头痛、眩晕、呼吸抑制等并发症的次数。结果：2组患者在Ramsay镇静评分、头痛、眩晕、呼吸抑制发生率、因疼痛调整药物剂量发生率等方面没有统计学差异，芬太尼组VAS评分显著低于吗啡组、而芬太尼组恶心、呕吐的发生率高于吗啡组。T0时刻，2组患者的MAP、HR、SpO₂没有统计学差异，T1、T2时刻，芬太尼组患者的MAP、HR高于吗啡组，T3、T4时刻，芬太尼组患者的MAP、HR低于吗啡组，SpO₂在T0~T4时刻之间无统计学差异。组内比较显示，吗啡组患者T1、T2时刻MAP、HR低于T0，T3、T4时刻MAP、HR高于T0，SpO₂在T0~T4时刻之间无统计学差异；而芬太尼组患者MAP、HR、SpO₂在T0~T4时刻之间均无统计学差异。结论：房颤射频消融术中，芬太尼镇痛效果优于吗啡，且对心率、血压的影响较小，但其恶心、呕吐的发生率较吗啡组高。

Abstract: Objective: The objective is to investigate the analgesic effect of morphine and fentanyl in radiofrequency ablation of atrial fibrillation. Methods: A total of 80 patients with atrial fibrillation, who were treated with radiofrequency ablation from September 2020 to May 2021, were enrolled in this study. All patients randomly divided into 2 groups, morphine or fentanyl was given intravenously slowly before radiofrequency ablation. Visual Analogue Score (VAS) and Ramsay sedation score were recorded after surgery. The mean arterial pressure (MAP), heart rate (HR), blood oxygen saturation (SpO₂) were observed at the time of entering the operating room (T0), after administration (T1), the start of the surgery (T2), 10 min after the start of radiofrequency ablation (T3), 10 min after the end of radiofrequency ablation (T4). The number of complications such as nausea, vomiting, headache, dizziness, and respiratory suppression was recorded. Results: There was no statistical difference in Ramsay sedation score, headache, vertigo, respiratory suppression, drug dose incidence adjusted for pain. The VAS score was significantly lower in fentanyl group than in morphine group. The incidence of nausea and vomiting in fentanyl group is higher than in the morphine group. There was no statistical difference in MAP, HR, SpO₂ in group 2 at T0. MAP and HR were higher in fentanyl group than in morphine group at T1, T2 and were lower in fentanyl group than in morphine group at T3, T4. There was no statistical difference in SpO₂ between T0~T4 moments. Within-group comparison showed that MAP, HR was lower at T1, T2 than at T0, and was higher at T3, T4 than at T0 in morphine group. There was no statistical difference in SpO₂ between T0~T4. There was no statistical difference between MAP, HR, SpO₂ between T0~T4 moments in fentanyl group. Conclusion: In radiofrequency ablation of atrial fibrillation, the analgesic effects of fentanyl were better than morphine, and had less effect on heart rate and blood pressure, but the incidence rate of nausea and vomiting was higher than in the morphine group.