羟考酮用于全子宫切除术后多模式镇痛的效果及对苏醒质量的影响

Effect of Oxycodone on multimodality postoperative analgesia and the quality of awakening in panhysterectomy

目的:观察羟考酮联合芬太尼用于妇科腔镜下行全子宫切除术患者术后镇痛的效果及对苏醒质量的影响,并与单独使用芬太尼比较。方法:选择妇科腔镜下全子宫切除术患者60例,随机平均分为芬太组(F组)和羟考酮联合芬太尼组(OF组)。两组均采用气管插管、全凭静脉麻醉。开始缝皮时F组静脉滴注芬太尼2μg/kg,OF组静脉滴注羟考酮0.1 mg/kg加芬太尼1μg/kg。记录用药前、用药后10、20、30 min的血压(Bp)、心率(HR)、血氧饱和度(Sp O_2);记录两组患者呼吸恢复时间、定向力恢复时间和拔管时间;观察两组患者在术后1、2、4、8 h疼痛视觉模拟评分(VAS评分)、镇静程度评分(Ramsay评分)、患者总体满意度,以及不良反应发生情况。结果:用药前后两组患者的血压、心率、血氧饱和度比较,差异无统计学意义(P>0.05)。OF组在术后各时间点的疼痛VAS评分、镇静Ramsay评分显著低于F组,差异有统计学意义(P<0.05)。OF组患者的自主呼吸恢复时间、定向力恢复时间和拔除气管导管时间较F组明显缩短,两组的总不良反应发生率比较,差异无统计学意义(P>0.05)。OF组对术后镇痛的总体满意率显著高于F组。结论:羟考酮联合芬太尼用于腹腔镜下全子宫切除术后镇痛效果确切可靠,患者术后的总体满意度高。

Objective To observe the effect of Fentanyl combing with oxycodone to cure postoperative analgesia and the quality of awakening in hysterectomy and compare with fentanyl alone. Method 60 patients（ ASA Ⅰ ~ Ⅱ） acceptted gynecological laparoscopic hysterectomy were divided into two groups randomly： fentanyl group（ F group,n = 30） and the group of oxycodone combined with fentanyl（ OF group,n = 30）. Two groups were given tracheal cannula and intravenous anesthesia. F group was given fentanyl 2μg / kg by intravenous injection,OF group were given oxycodone 0. 1mg / kg and fentanyl 1μg / kg by the same way when beginning sewing skin and the drugs given were diluted to 10 ml in 0. 9% saline. MAP 、HR 、Sp O_2 before drug and 10 min 、20 min、30 min after drugwere recorded; Recording the time from Discontinuation to spontaneous breathing recovery,to orientation recovery and to extubation. Scales of VAS and RASS of 1 h、2 h、4 h、8 h after operation were recorded. And degree of satisfaction and adverse reactions were recorded too. Results MAP,HR,Sp O_2 were no significant difference in two groups（ P〈0. 05）. Scales of VAS and RASS of OF group was significantly lower than that in F group（ P〈0. 05）,Adverse reactions were no significant difference in two groups（ P〈0. 05）. Degree of satisfaction in OF group were significantly higher than that in F group. Conclusion Fentanyl combined with oxycodone for postoperative analgesia of laparoscopic hysterectomy are safe and effective,the degree of satisfaction of patients was higher than fentanyl.