不同剂量羟考酮PCEA与PCIA用于前列腺术后镇痛效果比较

Analgesic effects of different doses of oxycodone for PCEA and PCIA after prostatectomy

目的探讨不同剂量羟考酮通过患者硬膜外自控镇痛(PCEA)与患者静脉自控镇痛(PCIA)用于前列腺术后的镇痛效果。方法选取在2018年1月~2020年1月期间于我院行前列腺术的210例患者,采用随机数字表法将患者分成A1、A2、A3、B1、B2、B36组,每组各35例。其中A1、A2、A3组术后镇痛采用PCIA方案,分别使用0.6mg/kg、0.8mg/kg、1.0mg/kg的羟考酮+托烷司琼10mg+0.9%氯化钠溶液至100mL;B1、B2、B3术后镇痛采取PCEA方案,分别使用0.6mg/kg、0.8mg/kg、1.0mg/kg的羟考酮+托烷司琼10mg+0.9%氯化钠溶液至100mL。比较手术前(T0)、术后6h(T1)、术后12h(T2)、术后24h(T3)及术后48h(T4)6组患者的生命体征、视觉疼痛模拟评分(VAS)及不良反应的发生情况。结果各组患者在不同时间点的MAP、HR及SPO 2的水平比较差异无统计学意义(P>0.05)。B1、B2、B3组患者分别在T1、T2、T3、T4时间的VAS评分显著低于A1、A2、A3组(均P<0.05),A2、A3组患者分别在T1、T2、T3、T4时间的VAS评分显著低于A1组(均P<0.05),B2、B3组患者分别在T1、T2、T3、T4时间的VAS评分显著低于B1组(均P<0.05)。B1、B2、B3不良反应的发生率分别显著低于A1、A2、A3组(均P<0.05)。B1、B2不良反应的发生率显著低于A2、A3组(P<0.05),且A3组不良反应的发生率显著高于A1、A2,B3组的不良反应的发生率显著高于B1、B2组(均P<0.05)。结论对前列腺手术患者术后,不同剂量羟考酮PCEA的镇痛效果及不良反应发生率均显著优于不同剂量羟考酮的PCIA,且当羟考酮的剂量为0.8mg/kg时,效果最佳。

Objective To explore the analgesic effect of different doses of oxycodone intravenous patient-controlled analgesia(PCIA)and epidural patient-controlled analgesia(PCEA)for patients after prostate surgery and provide an optimal choice for clinical treatment.Methods 210 patients who underwent prostatectomy in our hospital from January 2018 to January 2020 were randomly divided into 6 groups A1,A2,A3,B1,B2 and B3,with 35 cases in each group.PCIA scheme was used for postoperative analgesia in groups A1,A2 and A3.Oxycodone+tropisetron 10mg+0.9%sodium chloride solution of 0.6mg/kg,0.8mg/kg and 1.0mg/kg were used to 100mL respectively.PCEA scheme was used for postoperative analgesia in groups B1,B2 and B3.Oxycodone+tropisetron 10mg+0.9%sodium chloride solution of 0.6mg/kg,0.8mg/kg and 1.0mg/kg were used to 100ml respectively.The vital signs,visual pain analogue scale(VAS)and adverse reactions of 6 groups were compared before operation(T0),6h(T1),12h(T2),24h(T3)and 48h(T4).Results There was no significant difference in the levels of map,HR and SPO(2)at different time points in each group(P>0.05).The VAS scores of group B1,B2 and B3 at T1,T2,T3 and T4 were significantly lower than those of group A1,A2 and A3(all P<0.05),the VAS scores of group A2 and A3 at T1,T2,T3 and T4 were significantly lower than those of group A1(all P<0.05),and the VAS scores of group B2 and B3 at T1,T2,T3 and T4 were significantly lower than those of group B1(all P<0.05).The incidence of adverse reactions in B1,B2 and B3 groups were significantly lower than those in A1,A2 and A3 groups(all P<0.05).The incidence of adverse reactions in B1 and B2 was significantly lower than that in A2 and A3 groups(P<0.05),and the incidence of adverse reactions in A3 group was significantly higher than that in A1 and A2.The incidence of adverse reactions in B3 group was significantly higher than that in B1 and B2 groups(all P<0.05).Conclusion For prostate surgery patients,the analgesic effect and incidence of adverse reactions of different doses of oxycodone PCEA are significantly better than different doses of oxycodone PCIA,and when the dose of oxycodone is 0.8 mg/kg,Best effect.