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| 羟考酮在腹腔镜全子宫切除术后镇痛中的应用 |
| Effect of oxycodone for postoperative analgesia of laparoscopic total hysterectomy |
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| DOI：10.12089/jca.2019.01.009 |
| 中文关键词: 羟考酮 镇痛,患者自控 腹腔镜,全子宫切除手术 |
| 英文关键词: Oxycodone Analgesia Patient-controlled Laparoscope Total hysterectomy |
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| 中文摘要: |
目的 观察羟考酮不同镇痛方案在腹腔镜全子宫切除术后自控静脉镇痛中的应用效果。
方法 选择择期全麻下行腹腔镜全子宫切除术患者75例,年龄40~65岁，BMI 18～24 kg/m2,ASA Ⅰ或Ⅱ级,采用随机数字表法均分为三组:吗啡组(M组)、羟考酮持续背景剂量组(O1组)和羟考酮无背景剂量组(O2组)。三组静脉注射芬太尼4 μg/kg、丙泊酚2～2.5 mg/kg、顺式阿曲库铵0.2 mg/kg行麻醉诱导。M组术后镇痛泵药物为吗啡50 mg+昂丹司琼8 mg加生理盐水至100 ml,背景剂量2 ml/h,PCA剂量0.5 ml,锁定时间5 min;O1和O2组术后镇痛泵药物为羟考酮50 mg+昂丹司琼8 mg加生理盐水到100 ml,O1组背景剂量2 ml/h,PCA剂量0.5 ml,锁定时间5 min;O2组无背景剂量,PCA 4 ml,锁定时间5 min。记录术后4、8、12、24和48 h的NRS评分;记录术后48 h内补救镇痛次数、镇痛药用量和术后48 h内不良反应发生情况。
结果 O1、O2组术后4、8、12 h 静态NRS评分明显低于M组(P<0.05);O1、O2组术后4、8 h动态NRS评分明显低于M组(P<0.05);M组术后48 h内补救镇痛次数明显多于O1、O2组(P<0.05);O2组术后48 h内镇痛药总用量及不良反应发生率明显低于M、O1组(P<0.05)。
结论 羟考酮较之吗啡在腹腔镜全子宫切除术后静脉镇痛中可以起到更好的镇痛效果并降低术后恶心呕吐的发生率。 |
| 英文摘要: |
Ojective To observe the effect of oxycodone for postoperative patient-controlled intravenous analgesia of laparoscopic total hysterectomy with or without background infusion.
Methods Seventy five patients,aged 40 - 65 years, BMI 18 - 24 kg/m2, ASA physical status Ⅰ or Ⅱ, scheduled for elective laparoscopic total hysterectomy surgery under general anesthesia were randomly assigned into 3 equal groups(n = 25 each) using a random number table: morphine group (group M), oxycodone with background infusion group (group O1) and oxycodone without background infusion group (group O2). The anesthesia was induced by intravenous fentanyl 4 μg/kg, propofol 2 - 2.5 mg/kg and cisatracurium 0.2 mg/kg. Group M was given morphine 50 mg+ondanstron 8 mg in 100 ml normal saline, groups O1 and O2 were given oxycodone 50 mg + ondanstron 8 mg in 100 ml normal saline. The PCIA pump of group M and group O1 were set up with a 0.5 ml bolus dose, a 5 min lockout interval and background infusion at a rate of 2 ml/h. Group O2 was set up with a 4 ml bolus dose, a 5 min lockout interval and without background infusion. The NRS scores of three groups at 4, 8, 12, 24 and 48 h after operation were recorded. The total morphine or oxycodone consumption, and the number of rescue analgesia within 48 h after surgery were recorded. The adverse events within 48 h after surgery were also observed.
Results Compared with group M, the NRS scores at rest were significantly decreased at 4, 8, and 12 h after operation(P < 0.05), and the NRS scores at movement were significantly decreased at 4 and 8 h after operation(P < 0.05), and the number of rescue analgesia within 48 h after surgery was significantly decreased in groups O1 and O2 (P < 0.05). The total analgesic consumption and the incidence of adverse event within 48 h after surgery in group O2 were significantly lower than those in groups M and O1 (P < 0.05).
Conclusion Compared with morphine, oxycodone for patient-controlled intravenous analgesia can obtain more satisfactory effects after laparoscopic total hysterectomy surgery. Meanwhile, the total consumption of oxycodone and the incidence of nausea and vomiting are significantly decreased. |
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