羟考酮联合小剂量纳美芬在预防瑞芬太尼诱发患者术后痛觉过敏的临床价值

Clinical value of oxycodone combined with low-dose nalmefene in preventing postoperative hyperalgesia induced by remifentanil

目的探讨羟考酮联合小剂量纳美芬在预防瑞芬太尼诱发患者术后痛觉过敏的临床价值。方法选取2017年9月~2019年3月陆军军医大学附属第二医院择期行妇科腹腔镜手术的患者184例,采用随机数字表法分为对照组、羟考酮组、纳美芬组和联合组,每组各46例。于手术结束缝皮前,羟考酮组给予羟考酮(0.1 mg/kg),纳美芬组给予纳美芬(0.1μg/kg),联合组给予羟考酮(0.1 mg/kg)+纳美芬(0.1μg/kg)静脉缓慢注入以预防瑞芬太尼诱发患者术后痛觉过敏,对照组给予等量生理盐水。比较术前、术后30、90、180 min各组患者视觉模拟评分法(VAS)评分手术时间、术后患者意识恢复时间、拔管时间及术后不良反应情况。结果4组手术时间无显著性差异(P>0.05),但纳美芬组和联合组的意识恢复时间及拔管时间显著短于羟考酮组和对照组,差异具有统计学意义(P<0.05)。联合组在术后30 min、90 min、180 min时的VAS评分显著低于纳美芬组、羟考酮组和对照组(P<0.05)。4组患者出现恶心呕吐、嗜睡、头晕及躁动等不良反应情况无统计学差异(P>0.05)。结论羟考酮联合小剂量纳美芬有助于预防瑞芬太尼诱发患者术后痛觉过敏,能够缩短拔管及苏醒时间,且不增加不良反应发生风险。

Objective To explore the clinical value of oxycodone combined with low-dose nalmefene in preventing remifentanil-induced postoperative hyperalgesia in patients.Methods 184 patients underwent elective gynecologic laparoscopic surgery in the hospital from September 2017 to March 2019 were enrolled.They were divided into control group,oxycodone group,nalmefene group and and combination group by random number table method,46 cases in each group.Before anesthesia induction,oxycodone group was given oxycodone(0.1 mg/kg),nalmefene group was given nalmefene(0.1μg/kg),combination group was given oxycodone(0.1 mg/kg)and nalmefene(0.1μg/kg)to prevent remifentanil-induced postoperative hyperalgesia,and control group was given the same amount of normal saline.Before skin suture after end of surgery,at 30min,90min and 180 min after surgery,VAS scoring was performed on patients.The operation time,postoperative awareness recovery time,extubation time,intraoperative drug dosage and postoperative adverse reactions were recorded.Results There was no significant difference in operation time among the four groups(P>0.05).However,awareness recovery time and extubation time in nalmefene group and combination group were significantly shorter than those in oxycodone group and control group(P<0.05).At 30min,90min and 180 min after surgery,VAS scores in combination group were significantly lower than those in nalmefene group,oxycodone group and control group(P<0.05).There were no significant differences in adverse reactions such as nausea and vomiting,lethargy,dizziness and agitation among the four groups(P>0.05).Conclusion Oxycodone combined with low-dose nalmefene is conducive to preventing remifentanil-induced postoperative hyperalgesia,shortening extubation and recovery time,without increasing occurrence risk of adverse reactions.