羟考酮复合舒芬太尼与舒芬太尼在脑肿瘤切除术术后镇痛作用的比较

A comparison of oxycodone+ sulfentanyl and sulfentanyl in postoperative analgesia of brain tumor resection

目的比较羟考酮复合舒芬太尼与舒芬太尼在脑肿瘤切除术术后镇痛中的效果与不良反应。方法共募集行择期脑肿瘤切除术的患者58例,随机分为舒芬太尼镇痛组(SF组)32例和羟考酮+舒芬太尼联合镇痛组(OSF组)26例。SF组的镇痛泵配方为:舒芬太尼100μg+昂丹司琼8 mg稀释至100 ml。OSF组的镇痛泵配方为:舒芬太尼50μg+羟考酮20 mg+昂丹斯琼8 mg稀释至100 ml。观察术后6、24和48 h的循环参数(心率、平均动脉压和呼吸频率)、疼痛评分、术后不良反应(如恶心呕吐、皮肤瘙痒、尿潴留、镇痛不良、精神状态评分异常和头晕)的发生情况、术后排气时间、精神状态评分及活动状态。结果术后6 h OSF组的心率[(75.7±11.3)次/分vs.(81.3±9.4)次/分,P=0.048]和平均动脉压[(90.9±13.8)mmHg vs.(97.1±8.5)mmHg,P=0.049]均显著低于SF组,但两组间术后6 h呼吸频率差异无统计学意义(P>0.05)。OSF组的静息VAS评分[1.0(0~1.0)vs.1.0(1.0~1.0),P=0.047]和活动VAS评分[2.0(1.0~2.0)vs.2.0(1.3~3.0),P=0.026]均显著低于SF组。镇痛相关的不良反应发生率两组差异无统计学意义(P>0.05)。结论羟考酮与舒芬太尼联合镇痛可改善脑肿瘤切除术后6 h的镇痛评分,有助于维护血流动力学平稳。

Objective To compare the analgesic effects and adverse events between oxycodone＋ sulfentanyl and sulfentanyl in postoperative analgesia of brain tumor resection. Methods Fifty-eight patients undergoing elective resection of brain tumor were recruited. These patients were randomized into Group SF （n=32）and Group OSF （n=26）. In Group SF, PCIA was performed by sulfentayl 100 ilg plus ondansetron 8 mg, while in Group OSF PCIA was performed by sulfentayl 50μg, oxycodone 20 mg plus ondansetron 8 mg. Hemodynamic parameters and VAS scores were recorded at 6 h, 24 h and 48h following surgery. Anal exhaust time and adverse events were also analyzed. Results At 6 h follow-ing surgery, compares with Group SF, the heart rate[（75.7±11.3） beat/min vs. （81.3±9.4）beat/min, P = 0.048] and mean blood pressure[（90.9±13.8）mmHg vs. （97.1±8.5）mmHg, P = 0.049] were significantly lower in Group OSF, while there was no significant difference between the two groups in respiratory rate. Simultaneously, compared to Group SF, VAS scores at resting status [1.0（0-1.0） vs. 1.0 （1.0-1.0）, P = 0.047] and during activity [2.0（1.0-2.0） vs 2.0（1.3-3.0）, P = 0.026] were significantly lower in Group OSF. There were no obvious differences between the two groups in the incidences of analgesia related adverse events. Conclusion Oxycodone combined with sulfentanyl may improve VRS score and maintain stable hemodynamic status at 6h following brain tumor resection.