羟考酮在输尿管支架取出术中的应用

Application of oxycodone in the ureteral stent removal

目的测定羟考酮用于内镜下输尿管支架取出术镇痛的半数有效剂量(median effective dose,ED50),评估其安全性。方法选择收住日间病房拟行内镜下输尿管支架取出术的男性患者22例,年龄35～60岁,ASAⅠ或Ⅱ级,1个月前单侧输尿管钬激光碎石术后植入双J管。采用序贯给药法测定半数患者术中NRS评分≤3分时的羟考酮静脉注射剂量;同时记录术中血流动力学变化情况及呛咳、呼吸抑制、头晕、恶心、呕吐等不良反应的发生情况。结果羟考酮用于内镜下输尿管支架取出术镇痛的ED50为0.121mg/kg(95%CI 0.112～0.128mg/kg),术中血流动力学平稳,不引起呛咳,会引起轻至中度的呼吸抑制(12例),轻度头晕较常见(16例),术后恶心呕吐少见(1例)。结论序贯法测定羟考酮用于中青年男性患者内镜下输尿管支架取出术镇痛的ED50为0.121mg/kg,术中不良反应轻微,羟考酮是输尿管支架取出术镇痛的良好选择。

Objective To determine the median effective dose(ED50)of oxycodone-induced analgesia in the ureteral stent removal,and evaluate its safety.Methods Twenty-two male patients undergoing endoscopic ureteral stent removal in a day-care unit were selected:35-60 years old,ASA physical statusⅠ orⅡ,implanted double J tube after unilateral ureteral holmium laser lithotripsy one month ago.Sequential delivery method was applied to determine intravenous dose of oxycodone with which subjective NRS scores of half of patients were≤ 3 points during operation,meanwhile,intraoperative hemodynamic changes and adverse reactions,including cough,respiratory depression,dizziness,nausea and vomiting were recorded.Results ED50 of oxycodone was 0.121 mg/kg(95%CI 0.112-0.128 mg/kg),intraoperative hemodynamics was stable.It did not cause cough,however it did cause mild to moderate respiratory depression(12 cases),common mild dizziness(16 cases),rare nausea and vomiting(1 cases).Conclusion ED50 of oxycodone-induced analgesia for young and middle-aged male patients in endoscopic retrieving ureteral stent was 0.121 mg/kg,with intraoperative mild adverse reactions,oxycodone is a good option in the ureteral stent removal for analgesia.