羟考酮用于腹腔镜手术后患者自控静脉镇痛的临床效果

摘要

目的：观察羟考酮用于腹腔镜手术后患者自控静脉镇痛(PCIA)的效果。方法选择择期全麻下腹腔镜手术患者40例,年龄20~60岁,ASA Ⅰ或Ⅱ级,采用随机数字表法分为羟考酮组(A 组)和芬太尼组(B 组),每组20例。手术结束前 A 组给予羟考酮0.03 mg/kg,B 组给予芬太尼2μg/kg。两组患者入 PACU 后启动镇痛泵行 PCIA,输注速率2 ml/h,单次剂量4 ml,锁定时间15 min。分别在术后3、6、12、24、48 h 采用数字评分法(NRS)评估患者活动时、静息时的疼痛程度及内脏痛情况,记录不良反应情况。结果与 B 组比较,术后3~48 h 静息时 A 组 NRS 评分明显降低(P<0.05)；术后3、6、12 h 活动时 A 组 NRS 评分明显降低(P <0.05)；A 组内脏痛 NRS 评分明显降低(P <0.05)。两组恶心、呕吐、头晕、呼吸抑制发生率比较差异无统计学意义。结论羟考酮 PCIA能安全有效地抑制腹腔镜手术术后疼痛,在缓解腹腔内脏痛方面优于芬太尼。%Objective To observe the effects of PCIA with oxycodone after laparoscopic surger-y.Methods Forty ASA Ⅰ or Ⅱ patients aged 20-60 years undergoing laparoscopic surgery were as-signed to two groups randomly (n=20 per group):oxycodone group (group A)and fentanyl group (group B).Patients in group A received oxycodone (0.03 mg/kg)and patients in group B received fentanyl (2 μg/kg)at the end of surgery.The PCIA pump was turned on when the patients entered the PACU.The PCIA pump was set up with a 4 ml bolus dose,a 1 5 min lockout interval and a back-ground infusion at the rate of 2 ml/h.Numerical rating scale (NRS)was assessed for the patients in moving,in rest and visceral pain at 3,6,12,24 and 48 h after administration,and the adverse reactions were recorded.Results NRS scores of the rest and visceral pain were significantly lower in group A than in group B at each time point(P <0.05).NRS score of the movement were significantly lower in group A than in group B at 3,6 and 12 h after surgery (P <0.05).There was no significant difference in the incidences of nausea,vomiting,dizziness and respiratory depression between the two groups. Conclusion PCIA with oxycodone can safely and effectively inhibit pain after laparoscopic surgery. The effect of oxycodone for controlling the visceral pain was better than that of fentanyl.