不同剂量羟考酮超前镇痛对经腹子宫肌瘤剔除术术后疼痛及应激反应的影响

摘要

目的 探讨不同剂量羟考酮超前镇痛对经腹子宫肌瘤剔除术术后疼痛及应激反应的影响.方法80例择期全身麻醉下行经腹子宫肌瘤剔除术手术的患者,随机分为 A、B、C组和对照组,每组20例.分别于手术开始前30 min静脉注射:A组羟考酮0·05 mg/kg、B组羟考酮0·1 mg/kg、C组羟考酮0·15 mg/kg,对照组静脉注射等剂量的0·9% 氯化钠注射液.记录手术时间、麻醉药物用量、24 h内不良反应及哌替啶使用情况;采用疼痛模拟评分(VAS)和改良镇静-躁动评分(RASS)对患者术后1、6、12、24 h进行疼痛和镇静程度评分.在麻醉前、术后1、6、12、24 h测定血清中血糖和皮质醇水平.结果 与对照组比较,A、B和C组患者的VAS评分显著降低(P<0·05);与A组比较,B和C组VAS评分在术后1、6、12 h时显著降低(P<0·05);C组术后1 h时VAS评分低于B组(P<0·05);与对照组比较,A、B和C组术后1 h的RASS评分显著降低(P<0·05);C组术后1 h RASS评分低于A、B组(P<0·05).术后1、6、12、24 h血糖和血清皮质醇水平均高于麻醉前(P<0·05);与对照组比较,A、B和C组患者术后1、6、12、24 h血糖和血清皮质醇水平显著降低(P<0·05);与A组比较,B和C组术后1、6、12 h血糖和血清皮质醇水平显著降低(P<0·05),术后24 h,A、B和C 3组血糖和血清皮质醇水平差异无统计学意义(P>0·05).C组头晕、嗜睡和恶心呕吐发生率高于其他3组(P<0·05);对照组术后追加镇痛药物病例数多于其他3组(P<0·05);4组患者均无瘙痒、躁动、呼吸抑制及腹胀发生率差异无统计学意义(P>0·05).结论 0·1 mg/kg羟考酮用于超前镇痛可有效缓解术后疼痛且不良反应少,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 after transabdominal myomectomy.Methods Eighty patients were randomly assigned to four groups,20 cases in each group.0·05 mg/kg,0·1 mg/kg and 0·15 mg/kg oxycodone or 2 mL normal saline were administered intravenously 30 min before operation in group A,B,C and control group,respectively.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 1,6,12 and 24 h after the operation. Results Compared with control group,the VAS scores were significantly lower in group of A,B and C(P<0·05).Compared with A group,the VAS scores of the B and C groups were significantly reduced at 1,6,12 h after surgery(P<0·05).The VAS score of C group was lower than that of the B group(P<0·05).Compared with control group,the RASS scores were significantly lower in group A,B and C on 1 hour postoperatively(P<0·05).The RASS scores in group C were significantly lower compared to group A and B on 1 hour postoperatively (P<0·05).The blood glucose and serum cortisol of the four groups increased at 1,6,12 and 24 h after operation (P<0·05).Compared with control group,the levels of blood glucose and serum cortisol were significantly re-duced in 1,6,12,24 h in A,B and C groups(P<0·05).Compared with group A,1,6,12 h postoperative blood glucose and serum cortisol levels decreased significantly in B and C group(P<0·05).24 h after surgery,the level of blood glucose and serum cortisol in groups A,B and C have no differences(P>0·05).The incidence of dizziness,lethargy and nausea in C group was higher than that in the other 3 groups(P<0·05).More patients in control group needed analgesic drugs than those of other groups(P<0.05).There was no statistically signifi-cant difference between the four groups of patients without itching,restlessness,respiratory depression and ab-dominal distension(P>0·05).Conclusion Oxycodone at a dose of 0·1 mg/kg injected before the end of surgery could effectively relieve postoperative pain with less adverse reactions and postoperation stress response.