羟考酮用于术后患者自控静脉镇痛对老年结肠癌患者术后疼痛和胃肠功能的影响

Effects of intravenous oxycodone patient-controlled analgesia on postoperative pain management and gastroenteric function in elderly patients with colon cancer

目的观察羟考酮用于术后患者自控静脉镇痛(PCIA)对老年结肠癌患者术后急性疼痛和胃肠功能的影响。方法选择安徽医科大学附属省立医院2017-01/2018-01期间择期腹腔镜结肠癌根治术术后使用PCIA泵患者60例,年龄65～80岁,体质量指数(BMI) 18. 5～27 kg/m^2,ASA分级Ⅱ或Ⅲ级。采用随机数字表法分为吗啡组(M组,n=30)和羟考酮组(O组,n=30)。M组:术后给予吗啡1 mg/kg和盐酸托烷司琼8. 96 mg,生理盐水稀释至120 m L入泵; O组:术后给予羟考酮1 mg/kg和盐酸托烷司琼8. 96 mg,生理盐水稀释至120 m L入泵。记录2组患者术后1、4、8、24和48 h静息及咳嗽时VAS评分和Ramsay评分,记录2组患者术后胃肠功能恢复时间,包括首次肠鸣音、肛门排气和肛门排便时间。记录2组患者术后48 h镇痛泵有效次数和总按压次数,补救镇痛次数和恶心呕吐等不良反应发生情况。结果与M组比较,O组术后4、8、24和48 h静息及咳嗽时VAS评分降低(P <0. 05),术后48 h内镇痛泵按压次数、补救镇痛次数均减少(P <0. 05),术后胃肠功能恢复时间缩短(P <0. 05),不良反应发生率减少(P <0. 05)。结论羟考酮在为老年结肠癌患者提供有效的术后镇痛的同时,能缩短胃肠道恢复时间,且不良反应发生较少。

Objective To evaluate the effects of intravenous oxycodone patient-controlled analgesia on postoperative pain management and gastroenteric function in elderly patients with colon carcinoma. Methods Sixty patients aged 65-80 years old, BMI 18.5-27 kg/m2, of ASA Ⅱ or Ⅲ, scheduled for elective laparoscopic radical resection of colon cancer and received postoperative patient-controlled intravenous analgesia from January 2017 to January 2018 at The Affiliated Provincial Hospital of Anhui Medical University, were divided into morphine group（M group） and oxycodone group（O group） by means of a random number table. Group M contained morphine 1 mg/kg plus tropisetron hydrochloride 8.96 mg, diluted to 120 mL with normal saline. Group O contained oxycodone 1 mg/kg plus tropisetron hydrochloride 8.96 mg, diluted to 120 mL with normal saline. The VAS scores and Ramsay scores at rest and activity pain of the patients in two groups were documented at 1, 4, 8, 24 and 48 h after operation. The recovery of gastrointestinal function including the first gurgling sound resume time, the first passage of flatus and the first bowel movement were recorded. The PCA demands, additional analgesia drugs and adverse effects in 48 h after operation were compared. Results Compared with group M, VAS scores at rest and activity, PCA demands and adverse effects, the recovery time of gastrointestinal function were significantly decreased in group O（P〈0.05）. Conclusion Intravenous oxycodone provides effective postoperative analgesia, shortens the recovery time of gastrointestinal function and results in less postoperative complications in elderly patients with colon cancer.