羟考酮在剖宫产术后静脉自控镇痛中的应用

The use of the postoperative analgesia effects of oxycodone in cesarean section patients

目的:观察羟考酮联合酮咯酸氨丁三醇在剖宫产术后静脉自控镇痛(PCIA)中的效果。方法:选择蛛网膜下腔阻滞麻醉下行择期剖宫产手术的患者60例,ASAI^II级,随机分为舒芬太尼联合酮咯酸氨丁三醇组(ST组),羟考酮联合酮咯酸氨丁三醇组(QT组)。镇痛泵配方:ST组1μg/kg舒芬太尼+酮咯酸氨丁三醇1.5mg/kg+托烷司琼10mg;QT组1mg/kg羟考酮+酮咯酸氨丁三醇1.5mg/kg+托烷司琼10mg,均以生理盐水稀释至100ml。观察术后各时点的VAS评分、BCS评级及各时段的按压次数;术后48h内的不良反应及使用镇痛泵以外镇痛药的比率。结果:与ST组相比,QT组在术后4、6、12、24h的VAS评分显著降低、BCS评级显著升高、按压次数显著减少(P<0.05);QT组术后恶心呕吐发生率显著降低(P<0.05);ST组有3例患者使用镇痛泵以外的镇痛药,QT组无一例使用。结论:羟考酮联合酮咯酸氨丁三醇术后PCIA可有效的缓解剖宫产术后疼痛,且不增加不良反应的发生。

Objective：To evaluate the postoperative analgesia effects of oxycodone in cesarean section pa‐tients .Methods ：Sixty ASA I or II patients undergoing elective caesarean section were randomly divided into 2 groups （n= 30 each）：sufentanil with ketorolac tromethamine group （ST group） and oxycodone with ketorolac tromethamine group （QT group） .All of the patients received spinal anesthesia and patient‐controlled intravenous analgesia （PCIA） after operation .PCIA solution contained sufentanil （1μg/kg） ,ketorolac tromethamine （1 .5mg/kg） and tropisetron（10mg） in 100 ml of normal saline in ST group .Differently ,PCIA solution contained oxycodone （1mg/kg）、ketorolac tromethamine （1 .5mg/kg） and tropisetron（10mg） in 100 ml of normal saline in OT group . The VAS and BCS scores at 4 ,6 ,12 ,24 and 48 hours after operation were recorded respectively .Side effects of post‐operative analgesia ,press number of times and the use of analgesic except PCIA within 48 hours were also collected . Results：Compared with ST group ,VAS scores and press number of times at 4 ,6 ,12 ,and 24 hours in OT group af‐ter operation were reduced （P〈0 .05） .BCS scores at 4 ,6 ,12 ,and 24 hours in OT group after operation were in‐creased （P〈0 .05） .The incidence of nausea and vomiting after operation in OT group was reduced compared with that in the ST group （P〈0 .05） .There were three people have used analgesic except PCIA in ST group but no one in QT group .Conclusion：Oxycodone with ketorolac tromethamine in PCIA showed an improved postoperative analge‐sia in caesarean section patients without increasing side effects .