羟考酮用于Stanford A型主动脉夹层撕裂患者急诊手术前镇痛效果的影响

Preoperative analgesia effect of oxycodone in patients with Stanford type A aortic dissection

目的术前皮下注射羟考酮用于Stanford A型主动脉夹层撕裂患者,观察镇痛效果及不良反应。方法急诊行Stanford A型主动脉夹层撕裂术患者60例,男35例,女25例,年龄40~65岁,BMI 22~25 kg/m 2,ASAⅡ或Ⅲ级。采用随机数字表法将所有患者分为:吗啡组(M组)和羟考酮组(O组),每组30例。O组患者于麻醉诱导前30 min皮下注射羟考酮10 mg,M组患者于麻醉诱导前30 min皮下注射吗啡10 mg。记录给药前5 min(T0)、给药后5 min(T1)、10 min(T2)、15 min(T3)、20 min(T4)、25 min(T5)、30 min(T6)时HR、SBP、DBP、SpO2和RR。记录T0—T6时VAS评分、BIS及警觉与镇静评分(OAA/S评分)。记录给药后30 min内补救镇痛药物使用情况。患者对术前镇痛效果进行总体满意度评价。记录给药后30 min内患者窦性心动过速、窦性心动过缓、高血压、低血压、低氧血症、呼吸抑制、恶心、呕吐、皮肤瘙痒和寒战等不良反应发生情况。结果T1—T6时O组HR明显慢于M组(P<0.05),T2—T6时O组SBP和DBP明显低于M组(P<0.05)。两组患者不同时点SpO2和RR差异无统计学意义。T1—T6时O组VAS评分、BIS和OAA/S评分明显低于T0时,且O组VAS评分明显低于M组(P<0.05)。两组患者补救镇痛情况差异无统计学意义。O组患者总体满意度明显高于M组(P<0.05)。O组患者给药后高血压、呼吸抑制、恶心呕吐及皮肤瘙痒等发生率明显低于M组(P<0.05)。结论与吗啡比较,羟考酮用于急诊Stanford A型主动脉夹层撕裂术患者术前镇痛具有更好的临床效果,且不良反应更少,可有效提升患者的总体满意度。

Objective Preoperative subcutaneous injection of oxycodone was used in patients with Stanford type A aortic dissection,and to observe the analgesic effects and adverse reactions.Methods Sixty patients with Stanford type A aortic dissection,35 males and 25 females,aged 40 to 65 years old,with a BMI 22-25 kg/m 2 and falling into ASAⅡorⅢcategory,were scheduled to emergency surgery.All patients were divided into two groups by random number table:oxycodone group(group O)and morphine group(group M),30 cases in each group.Patients in group O were injected subcutaneously with oxycodone 10 mg 30 min before anesthesia.Patients in group M were injected subcutaneously with morphine 10 mg 30 min before anesthesia.HR,SBP,DBP,SpO2 and RR were recorded at 5 min(T0)before administration,5 min(T1),10 min(T2),15 min(T3),20 min(T4),25 min(T5),30 min(T6)after administration.Visual analogue scale(VAS),bispectral index(BIS),and alertness and sedation score(OAA/S score)were recorded from T0 to T6.The use of remedial analgesics was recorded within 30 min after administration.Patients were evaluated for overall patient satisfaction with preoperative analgesia.The incidence of sinus tachycardia,sinus bradycardia,hypertension,hypotension,hypoxemia,respiratory depression,nausea,vomiting,itchy skin,and shivering after 30 min administration were recorded.Results HR of group O was significantly slower than those of group M at T1-T6(P<0.05).SBP and DBP of group O were significantly lower than those of group M at T2-T6(P<0.05).There was no significant difference in SpO2 and RR between the two groups at different time points.Compared with T0,VAS score,BIS and OAA/S scores of group O were significantly lower at T1-T6,and VAS score of group O was significantly lower than that of group M at T1-T6(P<0.05).There was no significant difference in remedial analgesia rate between the two groups.Compared with group M,the overall satisfaction of patients in group O was significantly higher,the incidence of hypertension,respiratory depression,nausea and vomiting and skin itching was significantly lower in patients in group O(P<0.05).Conclusion Compared with morphine,oxycodone has a better clinical effect for preoperative analgesia in patients with emergency Stanford type A aortic dissection,and has fewer adverse reactions,which can effectively improve overall patients satisfaction.