术中静脉注射羟考酮对剖宫产产妇术后静脉自控镇痛的影响

Efficacy of intravenous oxycodone for postoperative patient-controlled analgesia in puerpera undergoing cesarean section under spinal anesthesia

目的 观察术中静脉注射羟考酮对腰麻下剖宫产产妇术后静脉自控镇痛的影响。方法 择期腰麻下行剖宫产术产妇80例,ASA I或II级,年龄23-34岁,体重53-81kg,按照随机数字表法均分为O组和C组,于缝合腹膜前,O组产妇静脉注射羟考酮0.1 mg∕kg,C组静脉注射相同体积生理盐水。记录手术结束即刻（T1）、术后1小时（T2）、4小时（T3）、8小时（T4）四个时间点产妇在静息状态及压宫底时的VAS评分,同时记录术后8小时内PCIA按压总次数及恶心呕吐、皮肤瘙痒、呼吸抑制等不良反应发生情况。结果与C组比较,O组产妇在各时间点按压宫底时的VAS评分降低（P〈0.05）,术后按压镇痛泵次数减少（P〈0.05）;静息状态VAS评分及术后呕吐、皮肤瘙痒、呼吸抑制等不良反应发生率差别无统计学意义（P〉0.05）。结论 术中静脉注射羟考酮0.1 mg/kg,可以提高腰麻下剖宫产产妇术后镇痛效果,但不增加不良反应的发生率。

Objective To evaluate the effect of intravenous oxycodone for postoperative patient- controlled analgesia in puerpera undergoing cesarean section under spinal anesthesia. Methods Eighty parturients scheduled for cesarean section under spinal anesthesia,ASAI or ASA II,aged 18 to 45 years,weighting 53 to 81 Kg,were randomized in two 40- patient groups,group O and group C. Before closing the peritoneum,intravenous oxycodone0. 1 mg ∕ kg for group O,the same volume of saline intravenously for group C. Visual analog scale for incision pain and uterine cramping pain were evaluated at recovery（ T1）,and 1（ T2）,4（ T3）,and 8（ T4） hours after the surgery. The frequency of PCA demands and the opioid- related side effects,such as PONV,pruritus,respiratory depression were recorded after surgery. Results Numerical pain rating scale for pain evaluation was significantly lower（ P〈0. 05） in group O than in group C at any time points. The frequency of PCA demands of group O was lower than that of group C. The occurrence of nausea and vomiting,pruritus and respiratory depression were not significantly different between the two groups during the first 8 postoperative hours. Conclusion Intravenous oxycodone 0. 1 mg / kg could increase postoperative analgesia for cesarean section under spinal anesthesia,but did not increase the incidence of adverse reactions.