口腔颌面部手术术后盐酸羟考酮辅助镇痛效果观察

Assisted analgesia effect of oxycodone hydrochloride after oral and maxillofacial surgery

目的:探讨盐酸羟考酮辅助术后镇痛对口腔颌面部手术患者术后疼痛程度及苏醒期并发症的影响。方法:选取2017年10月—2019年12月我院口腔颌面部手术患者106例,依据随机数字表法将患者分为研究组与对照组,每组各53例。对照组采取常规麻醉,研究组采取盐酸羟考酮辅助术后镇痛。对比2组围手术期血流动力学[心率(heart rate,HR)、平均动脉压(mean arterial pressure,MAP)],疼痛评分[视觉模拟量表(visual analogue scale,VAS),Prince-Henry疼痛评分(Prince-Henry pain score,PHS)],脑氧代谢指标[脑氧摄取率(cerebral extraction of oxygen,CEO_(2))、桡动脉-颈内静脉球部血氧含量差(arterial jugular vein oxygen content difference,Da-jvO_(2))],术后恢复情况,认知功能[简易精神状态评分(mini mental state assessment scale,MMSE评分)]及并发症情况。结果:术后2、6、24 h时,研究组MAP、HR均低于对照组(P<0.001);术后2、6、24 h时,研究组VAS、PHS评分,CEO_(2)、Da-jvO_(2)水平均低于对照组(P<0.001);研究组术后拔管时间与对照组差异无统计学意义(P>0.05),恢复自主呼吸时间、清醒时间小于对照组(P<0.001);术后2、6、24 h时,研究组MMSE评分高于对照组(P<0.001);研究组并发症发生率(5.66%)低于对照组(18.87%),差异有统计学意义(P<0.05)。结论:盐酸羟考酮辅助术后镇痛能进一步缓解口腔颌面部手术患者术后疼痛,利于维持脑氧代谢、血流动力学稳定,能降低并发症发生风险,且对认知功能影响小,安全性高。

Objective:To investigate the postoperative assisted analgesia effect of oxycodone hydrochloride on the levels of postoperative pain and complications during the anaesthesia recovery period of patients with oral and maxillofacial surgery.Methods:From October 2017 to December 2019,106 patients with oral and maxillofacial surgery in our hospital were selected and divided into the research group and the control group according to random number table method,each with 53 cases.The control group was given conventional anesthesia,and the research group was given postoperative oxycodone hydrochloride assisted analgesia.The perioperative hemodynamics[heart rate(HR),mean arterial pressure(MAP)],pain score[(visual analogue scale)VAS,Prince-Henry pain score(PHS)],cerebral oxygen metabolism indexes[cerebral extraction of oxygen(CEO_(2)),arterial jugular venous oxygen content difference(Da-jvO_(2))],postoperative recovery,cognitive function[mini mental state assessment scale(MMSE)score],and complications were compared and analyzed.Results:The MAP and HR of the research group were lower than those of the control group at 2 h,6 h and 24 h respectively after operation(P<0.001);the VAS,PHS scores and the levels of CEO_(2),and Da-jvO_(2) in the research group were lower than those of the control group at 2 h,6 h,and 24 h after surgery(P<0.001);there was no significant difference in the extubation time of endotracheal intubation between the research group and the control group(P>0.05),and the time to recover spontaneous breathing and awake was shorter than that of the control group(P<0.001);the MMSE score of the research group was higher than that of the control group at 2 h,6 h,and 24 h after surgery(P<0.001);the incidence of complications in the research group(5.66%)was lower than that of the control group(18.87%),the difference was statistically signficant(P<0.05).Conclusion:Postoperative administration of oxycodone hydrochloride assisted analgesia can further alleviate postoperative pain in patients with oral and maxillofacial surgery,which is beneficial to maintain cerebral oxygen metabolism and hemodynamic stability and reduce the risk of complications,as well as has less impacts on cognitive function recovery and higher safety.