不同剂量的羟考酮配伍舒芬太尼用于术后自控静脉镇痛的效果比较

Comparison of efficacy of different concentrations of oxycodone combined with sufentanil for postoperative patient-controlled intravenous analgesia

目的比较不同剂量的羟考酮与舒芬太尼配伍用于腹腔镜胃癌根治患者术后自控静脉镇痛(PCIA)中的效果及不良反应。方法收集60例择期行腹腔镜下胃癌根治术的患者,ASAⅠ～Ⅱ级,年龄47～76岁,体质量49～79 kg。入选患者采用随机双盲的方法分成A、B、C组,术后静脉镇痛分别使用0.05、0.1和0.15 mg·kg^(-1)的羟考酮配伍0.4 mg·L^(-1)舒芬太尼。术后静脉注射上述配方的药物负荷量5 mL;之后予以PCIA,参数:背景剂量2 mL·h^(-1),单次剂量2 mL,锁定时间15 min。分别于术后4、8、20、24、48 h记录患者的VAS评分和生命体征参数,并观察不良反应(镇静、呕吐、尿潴留、皮肤瘙痒和呼吸抑制)的发生情况。结果各组患者观察期间生命体征平稳。随着羟考酮剂量的增加,VAS评分逐渐下降(P<0.05)。术后48 h之内,B组和C组的总体VAS评分低于A组(P<0.05)。组间各时间点比较:术后4、8和20 h,B组和C组静止状态和活动状态VAS评分均低于A组(P<0.05)。C组术后4、8 h 2个时间点镇静(Ramsay)评分高于A组和B组(P<0.05);C组呕吐、皮肤瘙痒,尿潴留及过度镇静发生率显著高于A组和B组(P<0.05),A、B组间差异无统计学意义(P>0.05)。C组术后4 h有4例患者发生呼吸抑制。结论 0.1 mg·kg^(-1)的羟考酮与舒芬太尼相配伍,可安全有效地用于腹腔镜胃癌根治术后PCIA。

AIM To compare the efficacy and adverse drug reactions of different concentrations of oxycodone combined sufentanil for patient-controlled intravenous analgesia ( PCIA) after laparoscopic radical gastrectomy. METHODS Sixty patients,aged 47 - 76 years,ASA statusⅠ-Ⅱ,weighing 49 - 79 kg,undergoing laparoscopic radical gastrectomy were randomly assigned to group A,group B and group C respectively. Postoperative analgesia was administered with oxycodone 0. 05,0. 1 and 0. 15 mg·kg^-1 combined with 0. 4 mg·L^-1 sufentanil in group A,group B and group C respectively. All patients received background infusion of 2 mL·h^-1,and a bolus of 5 mL with a 15 min lock-out interval through patient-controlled analgesia devices. Visual analogue scale ( VAS) scores and vital signs were recorded at 4,8,20,24 and 48 h after operation,and adverse drug reactions ( sedation,vomiting,urinary retention,skin pruritus and respiratory depression) were observed. RESULTS Vital signs including SpO2,RR,HR,MAP of each group were stable during the observation period. VAS scores decreased when the concentration of oxycodone increased( P < 0. 05). In 48 h of postoperative analgesia,the overall VAS scores of group B and group C was lower than those of group A ( P < 0. 05). The comparison between groups: whether in static state or in active state,VAS scores in group B and group C were lower than those in group A( P <0. 05) at 4 h,8 h and 20 h after operation. In group C,the incidence rates of adverse drug reactions such as vomiting,skin pruritus,urinary retention and excessive sedation at 4 h and 8 h after operation were significantly higher than those of group A and group B ( P < 0. 05),and there was no significant differences between groups ( P > 0. 05) at the remaining time points. Four patients in group C developed respiratory depression 4 h after operation. CONCLUSION Oxycodone 0. 1 mg·kg^-1 combined with sufentanil can be safely applied in PCIA after laparoscopic radical gastrectomy.