羟考酮预处理在骨折术后镇痛中的作用及效果观察

Effect of oxycodone pretreatment in the fracture postoperative analgesia

目的观察羟考酮预处理在骨折术后镇痛中的作用及效果。方法选择2012年3月—2015年7月安徽中医药大学第一附属医院麻醉科择期接受全麻下骨科手术的患者98例,按住院顺序编号,随机分为对照组与观察组各49例,2组均给予镇痛处理,对照组应用芬太尼干预,观察组则应用盐酸羟考酮注射液干预,比较2组患者拔管时(T1)、拔管5 min(T2)、拔管0.5 h(T3)时心率(HR)、收缩压(SBP)、镇静(Ramsay)评分的变化,采用视觉模拟评分表(VAS)评定2组术后2 h、4 h、6 h、12 h、24 h疼痛程度,测定术前、术后24 h患者白介素6(IL-6)、肿瘤坏死因子α(TNF-α)水平的变化,计算术后不良事件发生率。结果(1)T1、T2时点,2组HR、SBP、Ramsay评分对比差异无统计学意义(P>0.05),观察组T3点SBP、HR低于对照组,Ramsay评分高于对照组(P均<0.05);(2)与术后2 h比较,2组术后其余各时间点VAS评分均上升(F=19.304、15.227,P均=0.000),但术后不同时间点观察组VAS评分均低于对照组(t=18.783、11.649、13.590、11.200、21.913,P均=0.000);(3)与同组术前比较,2组术后24 h IL-6、TNF-α水平均上升,差异有统计学意义(观察组:t=5.840、5.079,P均<0.05;对照组:t=11.908、11.238,P均=0.000),观察组上升幅度低于对照组(t=6.773、8.170,P<0.05);(4)2组术后不良反应及并发症发生率对比差异无统计学意义(P>0.05)。结论采用羟考酮对骨科手术患者作镇痛预处理,可减轻患者术后疼痛程度,稳定血流动力学,减轻机体炎性反应,且安全性较高。

Objective To analyze the effects of oxycodone preconditioning on postoperative analgesia in fracture.Methods From March 2012 to July 2015.in Anhui University of Traditional Chinese medicine,the First Affiliated Hospital,98 cases underwent elective surgery under general anesthesia in Department of orthopedics patients,according to admission order number,they divided into control group and observation group with 49 cases in each group,2 groups were given analgesic treatment,the control group was treated with fenlanyl intervention,observation group used oxycodone hydrochloride injection intervention,2 groups of patients were compared with extubalion（T1）,extubalion Smin（T2）,exiubation 0.5h（T3） and heart rate（HR）,systolic blood pressure（SBP）,sedation（Ramsay） score changes,using visual analogue scale（VAS） to assess of postoperative 2 h,4 h,6 h,12 h,24 h,H 2 groups of pain,preoperative,postoperative 24 h patients with inlerleukin 6（IL 6）,tumor necrosis factor alpha（TNF alpha） levels,statistical postoperative incidence of adverse events.Results（1） T1,T2 time,2 groups had no statistical significant differences of HR,SBP,Ramsay score（P〉0.05）,13 SBP.HR of the observation group lower than in the control group,Ramsay score higher than the control group（P〈0.05）;（2） 2 h alter the operation,the 2 groups＇ rest of the time points＇ VAS scores were increased（F =19.304,F =15.227,P =0.000）.but different lime points alter surgery of the observation group＇ s VAS scores were lower than the control group（t =18.783.t =11.649.;=13.590,t =11.200.t =21.913,P =0.000）;（3） compared with the same group before operalion,IL 6 and TNF alpha level increased in both of 2 groups 24 h after surgery,the difference was statistically significant（observation group：t =5.840,t=5.079,P〈0.05;control group：t = 11.908,t = 11.238,P =0.000）,the observation group increased degree significantly lower than the control group（t =6.773,t =8.170,P〈0.05）;（4） the incidence rate of adverse reaction and complication of the 2 groups showed no differences statistical significance（P〉0.05）.Conclusion Oxycodone analgesia for pretreatment of orthopedic surgery can reduce postoperative pain,stable hemodynamics,reduce inflammatory reaction,and with high safety.