羟考酮联合舒芬太尼用于剖宫产术后静脉镇痛的随机对照研究

Effect observation of patient-controlled intravenous analgesia using oxycodone combined with sufentanil after cesarean section:a randomized controlled trial

目的:探讨羟考酮联合舒芬太尼用于剖宫产术后静脉镇痛的临床疗效。方法:选择60例行择期剖宫产术的单胎初产妇,按随机数字表法分为羟考酮联合舒芬太尼组(OS组)和舒芬太尼组(SF组)。所有患者均采用腰硬联合阻滞,术后采用患者静脉自控镇痛(PCIA)。镇痛泵配方:OS组为羟考酮50 mg+舒芬太尼50μg+雷莫司琼0.3 mg,SF组为舒芬太尼100μg+雷莫司琼0.3mg。药液均用0.9%氯化钠溶液配至100mL,持续剂量1mL/h,冲击剂量2mL,锁定时间为10min。于术后6h、12h和24h记录随访活动时切口疼痛评分(NRS-M)、静息时切口疼痛评分(NRS-R)、宫缩痛评分(NRS-U)、镇痛泵药物消耗量、患者满意度评分及不良反应的发生情况。结果:OS组患者在各时点的NRS-M、NRS-R、NRS-U均低于SF组,按压次数及镇痛药的消耗量也低于SF组(P<0.05)。SF组术后恶心发生率高于OS组(P<0.05),呕吐、皮肤瘙痒、呼吸抑制、眩晕发生率两组差异无统计学意义。结论:剖宫产术后采用羟考酮联合舒芬太尼行PCIA效果优于单独使用舒芬太尼,且不增加不良反应。

Objective:To explore the effect of patient controlled intravenous analgesia(PCIA)using oxycodone combined with sufentanil on cesarean section patients.Methods:Sixty elective cesarean section patients were randomly divided into two groups:SF group(sufentanil100μg and ramosetron0.3mg),OS group(sufentanil50μg,oxycodone50mg,and ramosetron0.3mg).All patients were received combined spinal epidural anesthesia,and applied with PCIA after surgery.Making0.9%sodium chloride solution to100mL,continuous dosage1mL/h,pulse dosage2mL,the time was10min.Numerical pain scores of somatalgia at rest(NRS R)or movment(NRS M),numerical pain scores of uterine contraction(NRS U),patient controlled intravenous analgesia doses,and side effects were assessed at6h,12h and24h after the operation.Results:At the time points of6,12and24h after surgery,the scores of NRS M,NRS R,and NRS U in OS group were lower than those in SF group.Times of bolus and accumulated drugs consumption in OS group were less than those in SF group(P<0.05).The incidence of nausea in SF group was higher than that in OS group(P<0.05).There was no significant difference in the incidences of vomiting,dizziness,pruritus or respiratory depression between the two groups.Conclusions:Oxycodone combination with sufentanil in patient controlled intravenous analgesia may be more effective and without increasing side effects compared with sufentanil alone after cesarean section.