盐酸羟考酮在腹腔镜结直肠癌根治术术后静脉自控镇痛的应用效果

The effect of oxycodone hydrochloride controlled intravenous analgesia in laparoscopic resection of colorectal cancer after operation

目的：观察盐酸羟考酮用于腹腔镜结直肠癌根治术术后患者静脉自控镇痛（PCIA）的效果。方法选择40例需在全麻下行腹腔镜结直肠癌根治术的患者，年龄20～65岁，ASAⅠ～Ⅱ级，按数字表法随机分为羟考酮组（O 组）和芬太尼组（F 组），每组20例。O 组患者在手术结束前15 min 静脉给予羟考酮5 mg，F 组患者静脉给于芬太尼50μg。O 组0．6 mg·kg －1羟考酮和阿扎司琼10 mg 加生理盐水入泵至100 mL，F 组芬太尼15μg·kg －1和阿扎司琼10 mg 加生理盐水入泵至100 mL，两组患者入麻醉后监测治疗室（PACU）后启动镇痛泵行静脉自控镇痛（PCIA）。记录3、6、12、24、48 h 两组患者静息状态下 NRS 疼痛评分和内脏痛评分，记录术后48 h 镇痛泵有效按压次数、补救镇痛药物追加和不良反应发生情况。结果与 F 组比较，O 组患者术后3～24 h 静息状态下 NRS 评分和内脏痛评分明显降低（P ＜0．05），术后48 h 镇痛泵有效按压次数明显减少（P ＜0．05）；两组术后不良反应发生率相仿。结论盐酸羟考酮注射液 PCIA 可安全有效的用于腹腔镜结直肠癌根治术术后镇痛，在缓解内脏痛方面优于芬太尼。

Objective To investigate the effects of PCIA with oxycodone hydrochloride after colorectal cancer surgery by laparoscopy. Methods Forty ASAⅠorⅡ patients aged 20 ~65 years treated with colorectal cancer surgery by laparoscopy were assigned into two groups randomly （n =20 per group）：the oxycodone group （group O）and the fentanyl group （group F）.Patients in group O were giv-en oxycodone 5 mg while patients in group F were given fentanyl 50 μg at 15 min before the end of operation.PCIA in group O con-tained oxycodone 0.6 mg·kg -1 plus azasetron 10 mg,diluted to 100 ml with normal saline.PCIA in group F contained fentanyl 15 μg ·kg -1 plus azasetron 10 mg,diluted to 100 ml with normal saline.The PCIA pump was turned on when the patients entered the PACU. Quiescent condition pain and visceral pain were recorded based on numerical rating scale （NRS）at 3、6、12、24、48 h after surgery.The number of successfully delivered doses,additional remedy analgesic drug usage and adverse reactions were also recorded.Results NRS scores for both types of pain were significantly lower in group O than group F at each time point（P 〈0.05）after 24 hours.There was no significantly difference after 48 hours.The number of successfully delivered doses were less in group O than group F（P 〈0.05）.Ad-verse reaction rate of postoperative was similar.Conclusions PCIA with oxycodone hydrochloride can safely and effectively inhibit pain after colorectal cancer surgery by laparoscopy.Oxycodone hydrochloride for controlling the visceral pain was better than fentanyl.