盐酸羟考酮注射液复合酮咯酸氨丁三醇用于剖宫产术后镇痛的临床观察

The clinical observation of oxycodone hydrochloride injection combined with ketorolac tromethamine for post-cesarean analgesia

目的观察盐酸羟考酮注射液复合酮咯酸氨丁三醇用于剖宫产术后镇痛的效果及安全性。方法选择腰-硬联合麻醉下剖宫产手术患者75例,ASAⅠ或Ⅱ级,随机均分为盐酸羟考酮组(O组),盐酸羟考酮复合酮咯酸氨丁三醇组(OT组),酮咯酸氨丁三醇组(T组)。术后镇痛泵配方为O组羟考酮1 mg/kg+托烷司琼5 mg;OT组羟考酮0.5 mg/kg+酮咯酸氨丁三醇1.5 mg/kg+托烷司琼5 mg;T组酮咯酸氨丁三醇3 mg/kg+托烷司琼5 mg,三组均以生理盐水稀释至100 m L。观察术后6、12、24、48 h的切口痛VAS评分、宫缩痛评分及BCS评分;记录麻醉前、术后12、24、36 h血清P物质(SP)浓度;记录术后48 h内的不良反应,术后12、36 h的缩宫素使用量和子宫底高度。结果与T组比较,术后6、12、24 h O组和OT组的切口痛VAS评分和宫缩痛评分明显降低、BCS评分明显升高(P<0.05),术后12、24、36 h O组和OT组SP浓度明显降低(P<0.05),O组和OT组胃绞痛发生率明显降低(P<0.05)。与术前比较,三组患者术后12、24、36 h的SP浓度均明显升高(P<0.05)。结论盐酸羟考酮复合酮咯酸氨丁三醇用于剖宫产术后镇痛,镇痛效果好,不影响子宫复旧,不良反应少。

Objective To observe the analgesic effect and the safety assessment of oxycodone hydrochloride injection combined with ketorolac tromethamine for post-cesarean analgesia. Methods Seventy-five ASAⅠorⅡ patients scheduled for elective cesarean delivery under spinal-epidural anesthesia were equally randomized into three groups： oxycodone hydrochloride group（ group O）,oxycodone hydrochloride combined with ketorolac tromethamine group（ group OT） and ketorolac tromethamine group（ group T）. The drug contents in analgesia pump of the three groups were as follows. Group O： oxycodone（ 1 mg / kg） ＋ tropisetron（ 5 mg）; group OT： oxycodone（ 0. 5 mg / kg） ＋ Ketorolac tromethamine（ 1. 5 mg / kg） ＋ tropisetron（ 5 mg）; group T： Ketorolac tromethamine（ 3 mg/kg） ＋ tropisetron（ 5 mg）. All drugs were diluted to 100 m L with saline water. The following variables were recorded： the VAS scores of incision pain,uterine contraction pain scores and BCS scores at 6,12,24,48 h after surgery,SP concentration in serum were measured immediately before anesthesia and 12,24,36 h after surgery. The adverse effects within 48 h after surgery,the total consumption of the oxytocin and the height of fundus uterus at 12 h and 36 h were recorded. Results The incision VAS scores and uterine contraction pain scores in groups O and OT were lower than those in group T at each time point（ P〈0. 05）. The BCS scores in groups O and OT were higher than that in group T（ P〈0. 05）. The level of SP concentration at 12,24,and 36 h after surgery and the incidence of stomach ache in Groups O and OT were lower than group T（ P〈0. 05）. The PS concentration of all the groups at 12,24,and 36 h after surgery increased compared with before anesthesia（ P〈0. 05）. Conclusion Oxycodone hydrochloride injection combined with ketorolac tromethamine for post-cesarean analgesia could provide better analgesic effect without inhibiting uterus recovery and reduce the incidence of adverse effects.