Application Of Hydromorphone In Cardiac Radiofrequency Catheter Ablation In Patients With Atrial Fibrillation

Background and ObjectiveAtrial fibrillation is the most common clinical arrhythmia,with high morbidity and mortality,and poses a serious threat to the survival of patients.Transcatheter radiofrequency ablation can effectively prevent the recurrence of atrial fibrillation,and radiofrequency ablation is more effective in controlling sinus rhythm than antiarrhythmic drugs.Radiofrequency ablation is based on intracardiac electrophysiological examination.It performs a fine mapping of the key parts that cause arrhythmia,and then inputs certain energy through the catheter,which causes a“heat-burning effect”and causes irreversible damage to cells and intercellular substances.It further causes coagulation necrosis in the local myocardial tissue and forms an ablation line that blocks abnormal conduction.Transcatheter radiofrequency ablation for the treatment of atrial fibrillation has the advantages of minimal invasion,short time,and good surgical results.It can improve the quality of life of patients and prolong the lives of patients.It has been popularized clinically.In the treatment of atrial fibrillation during radiofrequency ablation,catheter stimulation of the atrium can cause severe pain to the patient.The potent opioid fentanyl is an analgesic commonly used in this type of surgery.It can effectively relieve pain,but it is prone to adverse reactions such as respiratory depression.Hydromorphone is a potent opioid analgesic.The analgesic effect of intravenous administration is 8.5 times that of morphine.It is highly fat-soluble,easily crosses the blood-brain barrier,and acts rapidly on the central nervous system.The degree is high,but hydromorphone has a shorter elimination half-life in the blood-brain barrier and less inhibits respiration.It has the characteristics of rapid onset,strong analgesic effect and less adverse reactions.Has been widely used for perioperative analgesia and acute and chronic pain treatment,can reduce the perioperative stress response and inflammatory response.Hydromorphone can be used to relieve moderate to severe pain caused by various causes.However,the use of hydromorphone in cardiac radiofrequency ablation of patients with atrial fibrillation has rarely been reported.This study intends to investigate the analgesic effect and safety of hydromorphone in patients undergoing cardiac radiofrequency ablation of atrial fibrillation,and to seek analgesic drugs that are more suitable for such patients.Methods120 patients undergoing elective cardiac radiofrequency ablation for atrial fibrillation were selected and classified as ASA I-III.All patients had no psychiatric,endocrine,and respiratory diseases,no hepatorenal dysfunction,and had not taken antidepressants,hypnosis,and towns recently.Pain medications have no previous history of cardiovascular surgery and no allergies after hydromorphone.All the enrolled patients were divided into 4 groups by random number table method:F group,H1 group,H2 group,H3 group,30 cases in each group,fasting for 8 hours before surgery,and ban drinking for 2 hours.A venous access was established after the patient entered the room,connected to ECG monitoring,oxygen mask,oxygen flow 5L/min.Monitor BP,HR,SpO₂,ECG,and RR.Before the start of surgery,intravenous drop injection of 1.25 mg of droperidol was used to prevent nausea and vomiting.After atrial septum puncture was successful,patients in group F were given intravenous fentanyl 1?g/kg,followed by sustained pumping at 1?g/?kg·h?,and fentanyl 0.5?g was given when the patient complained of pain or significant physical activity;Hydromorphone 0.01mg/kg intravenously in group H1,hydromorphone0.02mg/kg intravenously in group H2,and hydromorphone 0.03mg/kg intravenously in group H3,When the patient complained of pain or significant physical activity,hydromorphone 5?g/kg was given intravenously.Record the general data of the four groups of patients and the changes of MAP and SpO₂ at the time of operating room?T₀?,at the beginning of surgery?T₁?,radiofrequency ablation?T₂?,and at the end of the surgery?T₃?,and record the VAS score and Ramsay during ablation.Scores,as well as the use of remedial drugs during surgery,postoperative anesthesia-related complications,and patient satisfaction with anesthesia.Results1.There was no significant difference in general data of gender composition,age,weight,and operation time between the two groups?P>0.05?.2.Compared with T₀,the MAP at T₁ and T₂ in F group and H3 group increased significantly,and the MAP at T₁,T₂,and T₃ in H1 group and H2 group increased significantly?P<0.05?..Compared with group F and group H1,the MAP of group H2and group H3 decreased significantly,and the difference was statistically significant?P<0.05?.3.Compared with SpO₂ at T₀,SpO₂ decreased significantly at T₂ in F and H2groups,and SpO₂ decreased significantly at T₂ and T₃ in H3 group?P<0.05?.Compared with F group,H1 group and H2 group,SpO₂ in H3 group was significantly decreased at T₂,and the difference was statistically significant?P<0.05?.4.Compared with group F and group H1,VAS scores decreased significantly during the ablation of H2 and H3 groups?P<0.05?.Ramsay scores during ablation were significantly higher in groups H2 and H3 than in group F.The difference was statistically significant?P<0.05?.The proportion of people needing rescue drugs in H2 group and H3 group was significantly lower than that in F group and H1 group,and the difference was statistically significant?P<0.05?.Compared with group F,group H1 and group H3,the satisfaction rate of anesthesia in group H2 was significantly higher?P<0.05?.5.Compared with group F,group H1 and group H2,the incidence of nausea and vomiting in group H3 was significantly higher?P<0.05?.There was no significant difference in the incidence of respiratory depression,dizziness,dry mouth,and constipation among the four groups?P>0.05?.ConclusionHydromorphone has a good analgesic effect for cardiac radiofrequency ablation in patients with atrial fibrillation,and has good safety and can improve patient satisfaction with anesthesia.Intravenous injection of 0.02 mg/kg hydromorphone provides good analgesic effect without increasing the incidence of anesthesia-related adverse reactions,and is more suitable for cardiac radiofrequency ablation in patients with atrial fibrillation.