羟考酮注射液对前列腺电切术后镇痛及致痛物质的影响

Effect of Oxcycodone on Postoperative Analgesia and Algogenic Substances in Patients Undergoing the Transurethral Resection of the Prostate

目的探讨羟考酮注射液对行经尿道前列腺电切术(TURP)后静脉自控镇痛(PCIA)效果及对血浆致痛物质水平的影响。方法选择择期行TURP的患者120例,分为羟考酮组,舒芬太尼组和氢吗啡酮组各40例。所有患者术后均给予PCIA。所有患者分别于术后即刻(t1)、术后6 h(t2)、术后12 h(t3)、术后24 h(t4)、术后48 h(t5)时进行视觉模拟评分(VAS)、Ramsay镇静评分;分别测定麻醉前(t0)至t3时血浆P物质和5-羟色胺(5-HT)水平;记录术后48 h内PCIA泵按压次数、需补救镇痛例数及术后不良反应等。结果术后3组患者各时间点VAS和Ramsay镇静评分比较差异无统计学意义;与麻醉前比较,3组患者术后t1-t3时外周血浆P物质及5-HT浓度均明显升高(P<0.05);与舒芬太尼组和氢吗啡酮组相比,羟考酮组患者术后t1-t3时外周血P物质和5-HT浓度明显降低(P<0.05)。与羟考酮组比较,舒芬太尼组和氢吗啡酮组48 h内PCIA泵按压次数、膀胱痉挛和补救镇痛例数明显增多(P<0.05);与羟考酮组比较,舒芬太尼组和氢吗啡酮组的患者头晕、嗜睡和恶心呕吐发生率明显增多(P<0.05)。结论羟考酮注射液用于TURP患者术后PCIA时,患者血流动力学更加稳定,呼吸功能影响小,能有效缓解膀胱痉挛性疼痛,抑制围手术期应激因子的释放,镇痛效果满意,不良反应少,安全有效。

Objective To study the effect of oxycodone injection on postoperative pain in patients with self-controlled intravenous analgesia(PCIA) after transurethral resection of the prostate(TURP), and its effect on plasma levels of algogenic substances. Methods A total of 120 patients undergoing transurethral resection of the prostate was divided into three groups(group oxcycdone, group sufentanil and group hydromorphone).All patients were treated with PCIA for postoperative analgesia.The patients’ general parameters, ASA classification, and operation time were recorded.The VAS scores and Ramsay sedation scores were documented at the end of surgery(t1), 6 h(t2), 12 h(t3), 24 h(t4), and 48 h(t5) postoperatively.The plasma concentrations of substance P and serotonin(5-hydroxytamine,5-HT) were measured before anesthesia(t0), at t1, t2, and t3.Adverse reactions, the cases of additional analgesic consuming, the incidences of bladder spasm, PCIA pressing times were also recorded respectively. Results There were no significant differences about the general parameters after surgery.The differences among three groups of HR, MAP, SpO2, VAS scores and Ramsay scores had no statistical significance.Plasma substance P and 5-HT increased at t1 and t3 after surgery compared with the time before anesthesia(P<0.05), and group oxcycdone had lower plasma substance P and 5-HT at t1 and t3 than group sufentanil and hydromorphone had(P<0.05).PCIA pumping times, the amounts of additional analgesic consuming, and the incidences of bladder spasm in group sufentanil and hydromorphone were increased compared with group oxcycdone(P<0.05).Group sufentanil and hydromorphone had higher incidences of nausea, vomiting, dizziness and drowsiness reactions than group oxcycdone had(P<0.05).No respiratory depression was observed in all groups. Conclusion Oxycodone may effectively relieve postoperative pain after TURP, and it had little effect to respiratory and circulatory system with less side effects.It also had an inhibitory effect on the levels of substance P and 5-HT.