摘要：
目的 评价盐酸羟考酮注射液递减法背景输注在胸腔镜下肺叶切除患者术后镇痛的临床效果.方法 90例胸腔镜下肺叶切除患者,采用随机数字表法将患者随机分为舒芬太尼组(S组)、恒速羟考酮输注组(Q1组)和递减法背景输注羟考酮组(Q2组),每组30例.手术结束前10 min,S组给予舒芬太尼0.10μg/kg,Q1、Q2组给予羟考酮0.10 mg/kg,S组接电子泵舒芬太尼2.00μg/kg(100 ml),背景输注0.03μg/(kg·h),患者自控镇痛(PCA)剂量0.015μg/kg;Q1组羟考酮1.00 mg/kg(100 ml),背景剂量15.00μg/(kg·h),PCA剂量15.00μg/kg;Q2组羟考酮1.00 mg/kg(100 ml)术后第1个12 h背景输注15.00μg/(kg·h),之后每隔12 h减20.00%,PCA剂量15.00μg/kg,所有镇痛泵锁定时间10 min,每小时锁定4次.记录患者手术结束(T0)、拔管时(T1)和拔管后5 min(T2)有流动力学情况,同时记录患者术后2 h(T3)、8 h(T4)、12 h(T5)、24 h(T6)、48 h(T7)的静态数字疼痛评分(NRS)[NRS(R)],NRS(M)(动态NRS评分),Ramsay评分(镇静水平),PCA(次),药物补救次数,药物使用总量,呼吸抑制、恶心、呕吐和皮肤瘙痒等不良反应和患者术后镇痛的满意度.结果 3组患者拔管时平均动脉压(MAP)和心率(HR)均有升高,与手术结束时比较差异有统计学意义(P0.05);Q1、Q2组术后NRS(R)评分在(T3~5)时点低于S组,NRS(M)评分在(T3~6)时点低于S组(P 0.05). The score of NRS ? in the groups of Q1 and Q2 was lower than group S at the time of (T3~5) (P < 0.05), the score of NRS (M) in the groups of Q1 and Q2 was lower than group S at the time of (T3~6) also. The Ramsay score of Q1 and Q2 group was higher than the group S in the point (T3~7). Which the times of PCA and remedial drug use, sleep disturbed times in the first day and second day of group Q1 and Q2 was lower than the group S (P < 0.05). The volume of drug use at 48 h in the group of Q2 was lower than the group Q1 and S (P < 0.05). Postoperative nausea and vomiting of group Q2 was lowered than group S (P < 0.05). The satisfaction of Patients to postoperative analgesia in the group Q2 and Q1 was higher than group S (P < 0.05).Conclusion Lobectomy under thoracoscope patients with postoperative application of successive subtraction method background infusion oxycodone can obtain satisfactory analgesia effect with a smooth anesthesia recovery period, satisfied analgesic effect, reduce the dosage of drugs and reduce the adverse reaction.
