羟考酮与吗啡在腹部大、中型手术中的镇痛效果对比研究

Comparative study on analgesic effect in major and moderate abdominal surgery between oxycodone and morphine

目的 :比较羟考酮与吗啡用于腹部大、中型手术病人的镇痛效果。方法 :选取200例择期行腹部大、中型手术病人,包括胆囊切除术、胃癌根治术、结肠直肠手术和妇科肿瘤手术,ASA分级Ⅰ/Ⅱ级。分为羟考酮组(O组,n=100)和吗啡组(M组,n=100)。在停用瑞芬太尼前10 min静脉注射0.08 mg/kg羟考酮或吗啡,观察血流动力学指标、苏醒时间、拔管时间、疼痛视觉模拟评分(visual analogue scale,VAS)、自控镇痛按压次数、补救镇痛例数、警觉/镇痛评分(OAA/S),同时观察药物不良反应,并记录病人镇痛满意度。结果:O组和M组各时间点的心率和平均动脉压、苏醒时间、拔管时间无统计学差异(P>0.05)。O组VAS评分低于M组(P<0.05)。O组自控镇痛按压次数少于M组(P<0.05)。O组补救镇痛例数少于M组(P<0.05)。O组OAA/S评分和恶心、呕吐发生率低于M组(P<0.05)。两组均未出现呼吸抑制。结论:羟考酮在腹部大、中型手术后苏醒期镇痛的效果与安全性优于吗啡。既能对病人苏醒期起到镇痛作用,又为病人提供更舒适的术后镇痛,且无严重不良反应。

Objective To compare analgesic effect of oxycodone and morphine in the patients with major and moderate abdominal surgery. Methods Two hundred patients undergoing major and moderate abdominal surgery were enrolled in this study including cholecystectomy, radical surgery for gastric cancer and colorectal surgery, and gynecological cancer. The patients with ASA grades Ⅰ-Ⅱ were divided into oxycodone group（group O, n =100） and morphine group（group M, n =100）. Oxycodone or morphine 0.08 mg/kg was administered 10 min before stopping remifentani. Hemodynamic indexes, wake-up time, extubation time, pain visual analogue scale（VAS）, pressing number of patient-controlled analgesia（PCA）, the cases needing remedial analgesia, observer assessment of alertness/sedation（OAA/S） scale, adverse events and patient satisfaction were analyzed. Results There was no significant difference in heart rate and mean arterial pressure, wake-up and extubation time during postoperative period between group O and group M（P〈0.05）. Lower pain VAS was present in group O than in group M（P〉0.05）. Less pressing number of PCA was in group O（P〈0.05）. The cases needing remedial analgesia, OAA/S scale and the cases with nausea and vomiting in group O were significantly less than in group M（P〈0.05）. There was no case with respiratory depression in both groups. Conclusions Oxycodone can provide better and safer analgesia for anesthesia recovery after major and moderate abdominal surgery than morphine. It can not only serve as a more potent analgesic, but also provide more comfortable analgesia after surgery for patients and there were no serious adverse reactions.