盐酸羟考酮用于非体外循环冠状动脉旁路移植术后患者自控静脉镇痛的临床观察

Clinical observation of Oxycodone hydrochloride in patient-controlled intravenous analgesia after off-pump coronary artery bypass grafting

目的观察盐酸羟考酮用于非体外循环冠状动脉旁路移植术(CABG)后镇痛的临床效果,以期优化镇痛泵配方。方法回顾性分析2015年10月~2016年4月中国医学科学院阜外医院100例非体外循环CABG患者的临床资料。根据术后镇痛泵配方,分为羟考酮组(O组)和舒芬太尼组(S组),各50例。O组的镇痛泵配方为羟考酮(0.8 mg/kg)和托烷司琼(5 mg),S组的镇痛泵配方为舒芬太尼(1.5μg/kg)和托烷司琼(5 mg)。患者静脉自控镇痛(PCIA)自手术结束时开始。记录拔气管导管前30 min(T_1)、拔管即刻(T_2)、拔管后3 h(T_3)、拔管后24 h(T_4)的动脉收缩压(SBP)、舒张压(DBP)和心率(HR),T_2~T_4各时间点的疼痛和镇静评分、术后追加镇痛药、术后机械通气时长、重症监护室(ICU)停留时间、镇痛相关并发症等数据。结果 T_2时间点,O组患者SBP和HR均高于S组,差异均有统计学意义(P<0.05)。与T_1时间点比较,T_2时间点O组患者的SBP、DBP和HR与S组患者的SBP均明显升高,差异均有统计学意义(P<0.05)。患者疼痛和镇静评分、术后追加镇痛药、术后机械通气时长、重症监护室停留时间和镇痛相关并发症的组间比较,差异均无统计学意义(P>0.05)。结论盐酸羟考酮可安全、有效地用于非体外循环CABG患者的术后镇痛。两种不同配方镇痛泵(0.8 mg/kg羟考酮和1.5μg/kg舒芬太尼)的临床镇痛效果无明显差别,麻醉医生应根据自身经验和患者情况进行选择。

Objective To observe the clinical effects of Oxycodone hydrochloride on postoperative analgesia after offpump coronary artery bypass grafting（CABG） in order to optimize the prescription of analgesic pump. Methods Clinical data of off-pump CABG patients in Fuwai Hospital Chinese Academy of Medical Science from October 2015 to April2016 were retrospectively analyzed. According to the prescription of postoperative analgesic pump, the patients were divided into Oxycodone group（group O） and Sufentanil group（group S） with 50 cases in each group. The analgesic pump in group O was composed of Oxycodone（0.8 mg/kg） and tropisetron（5 mg）, and the analgesic pump formula in group S was Sufentanil（1.5 μg/kg） and tropisetron（5 mg）. Patient controlled intravenous analgesia（PCIA） began at the end of surgery. The arterial systolic blood pressure（SBP）, the arterial diastolic blood pressure（DBP） and the heart rate（HR） were collected at 30 min before extubation（T1）, the moment of extubation（T2）, 3 h after extubation（T3）, and 24 h after extubation（T4）. Pain and sedative scores at each time points of T2 to T4, additional postoperative analgesics, length of postoperative mechanical ventilation, length of intensive care unit（ICU） stay and analgesic related complications were collected. Results At the time point of T2, the HR and SBP of group O were higher than those of group S, the differences were statistically significant（P 〈 0.05）. At the time point of T2, the SBP, DBP, and HR of group O and the SBP of group S were increased significantly compared to the time point of T1 with statistical significance（P 〈 0.05）. There was no significant difference between groups in pain and sedative score, additional postoperative analgesics, length of postoperative mechanical ventilation, length of intensive care unit（ICU） stay and analgesic related complications（P 〉0.05）. Conclusion Oxycodone hydrochloride is safe and effective for postoperative analgesia in patients undergoing offpump CABG. There is no significant difference in the clinical analgesic effect between the two prescriptions（0.8 mg/kg Oxycodone and 1.5 μg/kg Sufentanil） of analgesia pumps, and the anesthesiologist should choose them according to their own experience and the patients′ condition.