文章摘要
羟考酮在老年患者后路腰椎融合术术后静脉自控镇痛中的应用
Application of oxycodone hydrochloride in the elderly undergoing posterior lumbar fusion surgery in patient controlled intravenous analgesia
  
DOI：10.12089/jca.2018.07.013
中文关键词: 盐酸羟考酮  舒芬太尼  后路腰椎融合术  术后镇痛
英文关键词: Oxycodone hydrochloride  Sufentanil  Posterior lumbar fusion surgery  Postoperative analgesia
基金项目:临床医学发展专项经费“扬帆”计划(ZYLX201818);北京市医院管理局“登峰计划”专项(DFL20150802)
作者单位E-mail
张燕 10053,首都医科大学宣武医院麻醉科,国家老年疾病临床研究中心  
范隆 10053,首都医科大学宣武医院麻醉科,国家老年疾病临床研究中心 lfan1976@126.com 
张苓 10053,首都医科大学宣武医院麻醉科,国家老年疾病临床研究中心  
付惠群 10053,首都医科大学宣武医院麻醉科,国家老年疾病临床研究中心  
阚敏慧 10053,首都医科大学宣武医院麻醉科,国家老年疾病临床研究中心  
张瑛 10053,首都医科大学宣武医院麻醉科,国家老年疾病临床研究中心  
葛明非 10053,首都医科大学宣武医院麻醉科,国家老年疾病临床研究中心  
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中文摘要:
      
目的 明确盐酸羟考酮在行后路腰椎融合术老年患者术后静脉自控镇痛(PCIA)中应用的可行性和有效性。

方法 选择后路腰椎融合术术后行PCIA的老年患者78例, 男29例, 女49例, 年龄65～85岁, BMI 18.5～35.5 kg/m2, ASA Ⅱ或Ⅲ级。随机分为两组：盐酸羟考酮组(Q组)与舒芬太尼组(S组),每组39例。记录两组患者术后4、8、16和24 h VAS评分和Ramsay评分。记录两组患者术后首次排气时间、尿管拔除时间、住院时间。记录两组患者恶心呕吐、眩晕、嗜睡、瘙痒、呼吸抑制、皮疹、寒战等不良反应情况。

结果 术后4、8、16和24 h时Q组VAS评分明显低于S组(P<0.05)。术后4和8 h时Q组Ramsay评分明显低于S组(P<0.05), 术后16和24 h时两组Ramsay评分差异无统计学意义。Q组术后恶心呕吐明显少于S组(P<0.05)。两组患者术后首次排气时间、尿管拔除时间、住院时间、眩晕发生率差异无统计学意义。两组患者术后均未出现嗜睡、瘙痒、呼吸抑制、皮疹、寒战等不良反应。

结论 盐酸羟考酮应用于老年患者后路腰椎融合术术后PCIA, 镇痛效果较舒芬太尼好, 发生不良反应较少。
英文摘要:
      
Objective To confirm the feasibility and efficacy of oxycodone hydrochloride in the elderly undergoing posterior lumbar fusion surgery in patient controlled intravenous analgesia (PCIA).

Methods Seventy-eight patients with PCIA after undergoing posterior lumbar fusion surgery, including 29 males and 49 females, aged 65 to 85 years, BMI 18.5 to 35.5 kg/m2, and ASA physical status Ⅱ to Ⅲ grade, were randomly divided into oxycodone hydrochloride group (group Q) and sufentanil group (group S). The VAS and Ramsay scores were recorded at 4, 8, 16, 24 h after surgery.The nausea, vomiting, dizziness, anal exhaust time, average length of catheter removal and the average length of stay were also analyzed.

Results The VAS scores at 4, 8, 16, 24 h after surgery were significantly better in group Q than in group S (P<0.05). Compared to group S, the Ramsay scores at 4, 8 h after surgery were significantly lower in group Q (P<0.05), while there was no significant difference between the two groups in the Ramsay scores at 16, 24 h after surgery. The incidence of nausea and vomiting in group Q were significantly lower than in group S (P<0.05) and there were no significant differences between the two groups in other indexs.

Conclusion Oxycodone hydrochloride shows better pain reliefing effects. The incidence of adverse reactions is lower. Based on these results, it could be concluded that oxycodone hydrochloride may improve VAS score and reduce the incidences of analgesia related adverse events for PCIA after posterior lumbar fusion surgery.
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