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| 不同背景剂量奥赛利定用于骨肿瘤切除术后患者自控静脉镇痛的效果 |
| Efficacy of different background doses of oliceridine for patient-controlled intravenous analgesia after bone tumor resection |
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| DOI：10.12089/jca.2025.08.002 |
| 中文关键词: 舒芬太尼 奥赛利定 术后镇痛 患者自控静脉镇痛 背景剂量 |
| 英文关键词: Sufentanil Oliceridine Postoperative analgesia Patient-controlled intravenous analgesia Background infusion |
| 基金项目:国家临床重点专科建设项目（ywb0007） |
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| 中文摘要: |
目的： 比较不同背景剂量奥赛利定用于骨肿瘤切除术后患者自控静脉镇痛（PCIA）的效果。
方法：选择择期全麻下行骨肿瘤切除术的患者91例，男43例，女48例，年龄18～64岁，BMI 18.5～28.0 kg/m2，ASA Ⅰ—Ⅲ级。术后48 h内行PCIA，镇痛方案为奥赛利定20 mg加生理盐水至100 ml，单次按压剂量1.8 ml（奥赛利定0.36 mg），锁定时间6 min。采用随机数字表法将患者分为三组：无背景剂量组（O组，n=30），背景剂量0.2 mg/h（奥赛利定1 ml/h）（O1组，n=30），背景剂量0.4 mg/h（奥赛利定2 ml/h）（O2组，n=31）。记录术后2、6、12、24、48 h静息和活动时NRS疼痛评分、Ramsay镇静评分。记录术后48 h镇痛泵有效按压次数、总按压次数、奥赛利定用量、曲马多和帕洛诺司琼使用情况、阿片类药物相关不良反应发生情况。记录术后首次肛门排气时间、术前及术后24、48 h 15项术后恢复质量（QoR-15）和满意度评分。
结果：与O组比较，O1组和O2组术后6、12、24和48 h活动时NRS疼痛评分明显降低，术后48 h镇痛泵有效按压次数、总按压次数明显减少，奥赛利定用量明显增加（P<0.05）；O1组术后首次肛门排气时间明显缩短，术后24、48 h QoR-15评分和满意度评分明显升高（P<0.05）。与O1组比较，O2组术后48 h镇痛泵有效按压次数、总按压次数明显减少，奥赛利定用量明显增加，恶心呕吐发生率明显升高，术后首次肛门排气时间明显延长，术后24、48 h QoR-15评分明显降低（P<0.05）。三组术后静息时NRS疼痛评分、Ramsay镇静评分、曲马多和帕洛诺司琼使用率和其他阿片类药物相关不良反应发生率差异无统计学意义。
结论：与奥赛利定背景剂量0.4 mg/h比较，奥赛利定背景剂量0.2 mg/h PCIA在保证镇痛效果的同时，减少阿片类药物用量，降低阿片类药物相关不良反应发生率，患者满意度高，并能有效改善术后早期恢复质量，是骨肿瘤切除患者术后镇痛更适宜的选择。 |
| 英文摘要: |
Objective: To compare the effects of patient-controlled intravenous analgesia (PCIA) with different background doses of oliceridine in patients after bone tumor resection.
Methods: Ninety-one patients who underwent elective bone tumor resection under general anesthesia were selected, 43 males and 48 females, aged 18-64 years, BMI 18.5-28.0 kg/m2, ASA physical status Ⅰ-Ⅲ. PCIA was performed within 48 hours after surgery: oxalidine 20 mg added to physiological saline to 100 ml, with a single press dose of 1.8 ml (olicerdine 0.36 mg) and a lock-out time of 6 minutes. The patients were divided into three groups using a random number table method: no background dose group (group O, n = 30), background dose of 0.2 mg/h (oliceridine 1 ml/h) group (group O1, n = 30), and background dose of 0.4 mg/h(oliceridine 2 ml/h) group (group O2, n = 31). The numerical rating scale (NRS) pain scores at rest and during activity, Ramsay sedation scores were recorded 2, 6, 12, 24, and 48 hours after surgery. The number of effective presses, total presses of the analgesic pump, the consumption of oliceridine, the use of tramadol and palonosetron, and the occurrence of opioid-related adverse reactions within 48 hours after surgery were recorded. The time of first flatvs, 15-item quality of recovery (QoR-15) before the surgery and at 24 and 48 hours after the surgery and satisfaction scores were also recorded.
Results: Compared with group O, the NRS pain scores during activity at 6, 12, 24 and 48 hours after surgery, the number of effective presses, and the total presses of the analgesic pump within 48 hours after surgery were significantly decreased, and the consumption of oliceridine was significantly increased in groups O1 and O2; the time of first flatus was significantly shortened, and QoR-15 score at 24, 48 hours after surgery and satisfaction scores were significantly increased in group O1 (P < 0.05). Compared with group O1, the number of effective presses and total presses of the analgesic pump within 48 hours after surgery were significantly decreased, the consumption of oliceridine and the incidence of nausea and vomiting were significantly increased, the time to first flatus was significantly prolonged, and QoR-15 score at 24, 48 hours after surgery was significantly decreased in group O2 (P < 0.05). There were no significant differences in the NRS pain scores at rest, Ramsay sedation scores, the use of tramadol and palonosetron, and the incidence of other opioid-related adverse reactions among the three groups.
Conclusion: Oliceridine PCIA with a background dose of 0.2 mg/h can ensure analgesic effect, reduce the consumption of opioid drugs, lower the incidence of opioid-related adverse reactions, improve patient satisfaction, and effectively improve the quality of early postoperative recovery. It is a more suitable choice for postoperative analgesia in patients undergoing bone tumor resection. |
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