术中给予不同剂量盐酸羟考酮在神经外科手术后镇痛与镇静效果的观察

Postoperative analgesia and sedation effects with different doses of oxycodone hydrochloride in neurosurgical operation

目的 观察术中给予不同剂量盐酸羟考酮在神经外科手术后的镇痛与镇静效果.方法 择期原发性面肌痉挛全麻下行枕后开颅显微血管减压术患者90例,随机分为3组,分别为羟考酮0.03 mg/kg组（H1组）、0.05 mg/kg组（H2组）、0.08 mg/kg组（H3组）.麻醉诱导后使用瑞芬太尼4 ng/ml靶控输注维持麻醉,丙泊酚5 ～6 mg· kg-1·h-1泵注,使BIS值维持在40 ～ 60.在开始缝合硬脑膜时,给予不同剂量盐酸羟考酮静脉滴注.记录3组患者给予羟考酮剂量、手术结束时BIS值、丙泊酚总量、麻醉维持时间、手术持续时间、给予羟考酮至手术结束时间、手术结束至自主呼吸恢复时间、清醒时间以及拔管时间、手术结束后10 min（T1）、20 min（T2）、30 min（T3）时患者VRS评分和SS评分以及不良反应.结果 3组患者术后10 min时VRS评分及SS评分差异无统计学意义.术后20 min时,H1组VRS评分高于H2、H3组（P＜0.05）,H1组SS评分低于H3组（P＜0.05）.术后30 min时,H1组VRS评分高于H2、H3组（P＜0.05）,H1、H2组SS评分均明显低于H3组（P＜0.05）.结论 术毕前给予盐酸羟考酮0.05 mg/kg可以达到良好的术后镇痛效果与满意的镇静程度.

Objective To observe the postoperative analgesia and sedation effects with different doses of oxycodone hydrochloride in patients undergoing neurosurgical operation.Methods Sixty patients with primary facial spasm scheduled for microvascular decompression under general anesthesia were randomly divided into 3 groups：0.03 mg/kg oxycodone group （group H1）,0.05 mg/kg oxycodone group （group H2）,0.08 mg/kg oxycodone group（group H3）.All the patients in the 3 groups were given remifentanil 4 ng/ml with target-controlled infusion and propofol 5-6 mg· kg-1· h-1 after induction.The BIS value was maintained in 40-60.Oxycodone was given in different doses by intravenous infusion when starting suturing dura mater.The consumption of oxycodone hydrochloride,BIS value of patients at the end of surgery,the amount of propofol used,anesthesia time,the duration of the operation,the time from drug delivery to the end of the operation,the spontaneous breathing recovery time after surgery,awaking time and extubation time,postoperative VRS and SS score in 10 min （T1）,20 min （T2）,30 min （T3）,as well as the occurrence rate of adverse reactions were all recorded.Results There were no statistical differences in VRS and SS at T1 among the three groups.The VRS in group H1 was higher than that in group H2 and H3 at T2 and T3.The SS in group H1 was lower than that in group H3 at T2,the SS in group H1 and H2 were significantly decreased compared with group H3 at T3.Conclusion Both analgesia effect and depth of sedation are satisfied with oxycodone hydrochloride 0.05 mg/kg before the end of neurosurgical operation.