盐酸羟考酮在乳腺癌改良根治手术后急性疼痛治疗中的应用

Oxycodone hydrochloride in postoperative analgesia in breast cancer patients undergoing modified radical mastectomy

目的探讨盐酸羟考酮用于乳腺癌改良根治手术后急性疼痛治疗的安全有效剂量。方法选择择期全麻下行乳腺癌改良根治手术女性患者100例,年龄29-69岁,BMI〈30kg/m2、ASA分级Ⅰ或Ⅱ级。采用随机数字表法,将其均分为两组：低剂量盐酸羟考酮组（OL组）和高剂量盐酸羟考酮组（OH组）。手术结束前30 min,OL组和OH组分别静注盐酸羟考酮注射液0.03和0.09mg/kg。术毕缝皮时停用麻醉药。疗效指标：于拔除喉罩后5min、0.5、2、4、8、12、24h行静态和动态VAS评分。记录手术后24h内补救镇痛药物使用情况及不良事件的发生情况。结果拔除喉罩后8和12hOH组静态和动态VAS评分明显低于OL组（P〈0.05）。两组术后镇痛满意率差异无统计学意义。两组PONV、头晕、瘙痒、排尿困难、窦性心动过缓等术后不良事件和追加镇痛药的发生率差异无统计学意义。结论 0.09mg/kg盐酸羟考酮可以安全有效地减轻乳腺癌改良根治手术后患者的急性疼痛。

Objective To evaluate the safety and effective dose of oxycodone hydrochloride injection for postoperative analgesia in breast cancer patients undergoing modified radical mastectomy under general anesthesia in a prospective,randomized controlled clinical trial.Methods One hundred female patients at ASAⅠorⅡ,aged 29-69 years,BMI30kg/m2,scheduled for elective modified radical mastectomy under general anesthesia,were randomly divided into two groups（n=50）：low dose oxycodone hydrochloride injection group（group OL）,and high dose oxycodone hydrochloride injection group（group OH）.Oxycodone 0.03mg/kg（group OL）and 0.09mg/kg（group OH）was intravenous injected 30 minutes before the end of the operation,respectively.Anesthetics usage was terminated when skin was sutured.Pain at rest and during movement was assessed using VAS score at 5min,0.5,2,4,8,12 and 24h after extubation of laryngeal mask.Total consumption of analgesic for rescue analgesia in the ward and the adverse events were recorded.Results Compared with group OL,group OH had lower VAS scores,There were significant differences in the VAS scores between groups at 8and 12 hafter surgery（P〈0.05）.No serious adverse event occurred in each group postoperatively.The most common adverse event was nausea,followed by vomiting and dizziness.There was no significant difference in the incidence of adverse event between the two groups.Conclusion 0.09mg/kg oxycodone hydrochloride injection is safe and effective in reducing pain after breast cancer radical operation.