Effects Of Patient-controlled Analgesia With Hydromorphone Or Sufentanil On Postoperative Pulmonary Complications In Patients Undergoing Thoracic Surgery

Objective:To compare the analgesic effects of patient-controlled intravenous analgesia(PCA)with hydromorphone or sufentanil after thoracic surgery on postoperative pulmonary complications(PPCs).Methods:A total of 142 patients who were scheduled for thoracic surgery were randomly allocated to receive PCA with hydromorphone(group A: experimental group): hydromorphone 0.2mg/kg+dezocine 0.5mg/kg+ramosetron 0.6mg diluted with normal saline to 200mL;or with sufentanil(group B: control group): sufentanil 3.0?g/kg+dezocine 0.5mg/ kg+ramosetron 0.6mg diluted with normal saline to 200 mL.The parameters of intravenous analgesia pump were set as background dose 4ml/h,PCA dose 1mL,locking time 15 min.Pain NRS(numerical rating scale),Ramsay sedation score,nausea or vomiting score were evaluated at 0h,6h,12 h,24h,48 h after operation.The cases of PPCs(atelectasis,pulmonary infection,respiratory failure),CRP(C-reaction protein)and inflammatory cells(white cell count and percentage of neutrophils)and blood gas analysis at 12 h after operation,length of ICU and postoperative stay were recorded for each patient.Results:Data of 136 patients were analyzed.(1)Compared with group B(4[IQR:2,2]),the pain NRS in group A(2[IQR:4,4])was significantly lower at 6h after operation(P=0.000).(2)The CRP in group A(69.79±32.13mg/L)were lower than group B(76.76±43.42mg/L)after operation,but the difference was not significant(P=0.427).(3)There was no significant difference of Ramsay sedation score between two groups.(4)No difference of nausea or vomiting was found between group A(7.3%)and group B(5.8%)postoperatively(P=0.999).(5)The PPCs were happened in 11 patients in group A(16.2%)and 22 patients in group B(32.4%)and the difference between two groups was significant(P=0.027).(6)Seven patients in group A(10.3%)and eighteen patients in group B(26.5%)had clinical evidence of pneumonia and the difference between two groups was significant(P=0.014).(7)The length of ICU and postoperative stay in group A were 2.73 h and 1.82 days less than group B respectively but the differences were not significant(P=0.234,P=0.186 respectively).Conclusions:Compared with sufentanil,hydromorphone may provide better postoperative analgesic effect with less pulmonary complications for patients undergoing thoracic surgery,and it may accelerate patients' rehabilitation.