氨酚羟考酮和曲马多用于骨科上肢手术患者术后镇痛的疗效观察

Observation on the Efficacy of Oxyeodone Acetaminophen or Tramadol for Postoperative Anal- gesia in Patients Undergoing Orthopedic Surgery of Upper Extremity

【目的】评价口服氨酚羟考酮用于骨科上肢手术患者术后镇痛的有效性和安全性。【方法】对90例骨科上肢手术行臂丛麻醉的患者随机分三组，即氨酚羟考酮组（A组）、曲马多（B组）和安慰剂（维生素C）组（C组），每组30例，三组患者均于术毕时口服第一片，当日为每6h服1片，直至入睡，最多3片；后每次1片，3次／日，再连续服用2d。视觉模拟评分（VAS）大于6分时，3组患者均肌注杜冷丁作为补救镇痛用药。观察并记录服药后1h（T1）、6h（T2）、12h（T3）、24h（T4）、48h（T5）、72h（T6）的VAS评分，术后早期功能锻炼VAS评分（翻身和咳嗽），不良反应的发生情况，术后第1夜、第2夜、第3夜的睡眠满意度及杜冷丁的用量。【结果]IA和B组在T2、T3、T4、T5、T6的休息VAS和功能锻炼（翻身和咳嗽）的VAS评分低于C组（P〈0．05），A组和B组之间VAs评分、睡眠满意度评分无统计学差异（P〉0．05），术后三个夜晚的睡眠满意度A和B组评分低于C组（P〈0．05）。A组和B组补救杜冷丁用量明显低于C组（P〈0．05），A组和B组补救杜冷丁用量无统计学差异（P〉0．05）。72h恶心呕吐率，三组相当（P〉0．05）。【结论】口服氨酚羟考酮和曲马多能有效地缓解骨科上肢手术患者术后的中至重度疼痛，从而能及早进行功能锻炼，降低围手术期的并发症发生率，促进病人早日康复；对于骨科行臂丛麻醉的患者术后口服给药镇痛的方式安全、有效。

[Objective]To observe the safety and efficacy of oral oxycodone acetaminophen for postoperative analgesia in patients undergoing upper limb orthopedic surgery. [Methods]Totally 90 patients scheduled for upper limb orthopedic surgery were randomly assigned to oxycodone acetaminophen group（group A）, tramadol group（group B） and placebo（vitamine C） group（group C） with 30 cases in each group. All patients orally took the first tablet at the end of the operation, then a tablet per 6h at the same day until the fall with no more than 3 tablets, and at last a tablet every time and tid for 2 days. When the VAS score was more than 6, all patients were given intramuscular injection with dolantin as a pain remedy. The VAS score, early postoperative exercise VAS score（turning over and cough） at lh（T1 ）, 6h（T2 ）, 12h（T3 ）, 24h（T4 ）, 48h（T5 ） and 72 h（T6） after taking medicine, the incidence of adverse reaction, sleep satisfaction at 1st, 2nd and 3rd night and the dosage of dolantin were observed and recorded. [Results] The rest VAS score and functional exercise VAS score（turning over and cough） at T2, T3 , T4 , T5 and T6 in group A and group B were lower than those in group C（ P 〈0.05）. There was no significant difference in VAS score and sleep satisfaction score between group A and group B（ P 〉0.05）. Sleep satisfaction in 3 nights after operation in group A and group B was lower than that in group C（ P 〈0.05）. The dosage of remedial dolantin in group A and group B was obviously lower than that in group C（P〈0.05）, but there was no significant difference in the dosage of dolantin between group A and group B（ P 〉0.05）. There was no significant difference in the 72h-nausea and vomiting rate among 3 groups（ P 〉0.05）. [Conclusion]Oral oxycodone aeetaminophen or tramadol can effectively alleviate the moderate and severe postoperative pain of patients undergoing upper limb orthopedic surgery, so early functional exercise can reduce the incidence of perioperative complications and promote the early recovery of patients. Oral drug administration for postoperative analgesia of patients undergoing orthopedic surgery under braehial plexus anesthesia is safe and effective.