不同剂量羟考酮治疗腰-硬联合麻醉剖宫产产妇寒战的疗效分析

Efficacy of different doses of oxycodone for the control of shivering after combined spinal-epidural anesthesia in puerperae undergoing caesarean section

目的:观察不同剂量羟考酮对产妇剖宫产手术腰-硬联合麻醉后寒战反应的治疗效果。方法:选择择期在腰-硬联合麻醉下行剖宫产手术中出现寒战的产妇100例,ASAⅠ~Ⅱ级。采用随机数字表法将产妇分为5组(n=20):0.9%氯化钠液(C)组,曲马多1mg/kg(T_)组,羟考酮20μg/kg(O_1)组、40μg/kg(O_2)组、80μg/kg(O_3)组。胎儿娩出后缓慢静脉注射相应药物。记录给药后即刻(T_1)和给药后5min(T_2)、10min(T_3)、15min(T_4)、20min(T_5)、30min(T_6)时血流动力学的变化,患者寒战情况及不良反应的发生情况。结果:各组患者寒战严重程度差异无统计学意义;T组、O_2组、O_3组寒战治愈率明显高于C组(90%、50%、75%vs 15%,P<0.05),T组与O__3组相比差异无统计学意义。T_1时寒战的缓解率在T组、O_3组差异无统计学意义(80%vs 60%)。T组恶心呕吐的发生率高于O_3组(P<0.05)。与其余4组比较,O_3组产妇术后镇痛的满意度最高(P<0.05)。结论:静脉给予80μg/kg羟考酮能够迅速有效治疗脊麻后寒战反应,并提高产妇术后镇痛的满意度。

Objective:To observe the clinical efficacy of the different dose of oxycodone on shivering in caesarean section after combined-spinal epidural anesthesia(CSEA).Methods:One hundred puerperae,ASA physical status Ⅰ-Ⅱ,scheduled for elective cesarean delivery under CESA were investigated.Puerperae who developed shivering after CSEA were randomly divided into five groups(n=20each)using a random number table:saline(Group C),tramadol 1mg/kg(Group T),oxycodone 20,40,and 80μg/kg groups(Group O_1,O_2,and O_3).All drugs were infused as a slow intravenous after fetal delivery.The shivering intensity,the changes of hemodynamic and adverse reaction in right after medication(T_1),after medication in 5min(T_2),10 min(T_3),15 min(T_4),20 min(T_5),30 min(T_6)were recorded.Results:There was no statistical significance of the shivering intensity found in each group.The shivering controlled rate in Group T,Group O_2,and Group O_3 were significantly higher than Group C(90%,50%,75% vs 15%,P<0.05),and no statistical significance was found in Group T and Group O_3.No statistical significance of shivering controlled in T_1 was found in Group T and that in Group O_3(80% vs 60%).The incidence of nausea and vomiting in Group T was higher than that in Group O_3(P<0.05).Compared with other four groups,the satisfaction rate of postoperative analgesia in Group O_3 was the highest(P<0.05).Conclusions:Oxycodone 80μg/kg produced a rapid and potent anti-shivering effect,which can improve the satisfaction rate of postoperative analgesia.