不同剂量羟考酮对妇科腹腔镜术后疼痛及应激反应的影响

摘要

目的：观察不同剂量羟考酮对妇科腹腔镜术后疼痛及应激反应的影响。方法择期行妇科腹腔镜手术患者60例,年龄18~50岁,随机均分为三组,每组20例。手术结束前15 min,C组静脉注射生理盐水5 ml,L 组静脉注射羟考酮0.05 mg/kg,H 组静脉注射羟考酮0.1 mg/kg。采用 VAS 评分和改良镇静-躁动评分(RASS)评价患者术后1、6、12、24 h 的疼痛和镇静程度。于麻醉前、术后6、12、24 h 测定血清中血糖和皮质醇水平。记录追加哌替啶及不良反应情况。结果 L 组和 H 组在术后1 h 的 VAS 评分明显低于 C 组(P <0.05)；H 组在术后6 h 的 VAS 评分明显低于 C组和 L 组(P <0.05)。L 组和 H 组在术后1 h 的 RASS 评分明显低于 C 组(P <0.05)。与麻醉前比较,术后6、12、24 h 三组血糖和血清皮质醇水平明显升高(P <0.05)。L 组和 H 组术后6、12 h 血糖和血清皮质醇水平明显低于 C 组(P <0.05)。三组无一例躁动、瘙痒和呼吸抑制,但均有1例(5%)恶心呕吐和头晕,组间差异无统计学意义。L 组和 H 组术后均有2例(10%)追加哌替啶,明显少于C 组的8例(40%)(P <0.05)。结论术毕前静脉注射羟考酮0.1 mg/kg,可有效缓解妇科腹腔镜术后疼痛,术后应激反应较轻。%Objective To investigate the effects of different doses of oxycodone on postoperative pain and stress response in patients undergoing gynecological laparoscopic surgery. Methods Sixty patients scheduled for gynecological laparoscopy,aging from 18 to 50 years old,of ASA Ⅰ or Ⅱ,were included and randomized into three groups:control group (group C),low dose of oxycodone group (group L),high dose of oxycodone group (group H),20 cases in each group.Pa-tients in group L,H received 0.05,0.1 mg/kg oxycodone respectively while paitents in group C re-ceived saline 5 ml 1 5 min before the end of the surgery.Visual analogue scale(VAS)pain score and RASS score were measured on 1,6,12 and 24 h postoperatively.Glucose and serum cortisol were also measured before the operation and on time points of 6,12 and 24 h after the operation.Adverse effects were recorded too.Results Compared with group C,VAS were significantly lower in group L and H within 1 hour postoperatively.(P <0.05).VAS was significantly lower in group H than that in group C and L at 6 h postoperatively (P <0.05 ).The RASS scores of group L and H were significantly lower than those in group C (P <0.05)at 1 h postoperatively.Blood glucose and serum cortisol of group L and H increased at 6,12 and 24 h after operation (P <0.05).Compared with group C,blood glucose and serum cortisol were significantly lower in group L and group H at 6,12 h after operation (P <0.05).There was no significant difference in the incidence of adverse reactions in each group. Conclusion Oxycodone 0.1 mg/kg injected before the end of gynecological laparoscopic surgery could effectively relieve postoperative pain with less adverse reactions,and decrease postoperation stress re-sponse.