羟考酮用于妇科腹腔镜手术多模式镇痛对患者苏醒质量及血流动力学的影响

Effects of oxycodone multimodal analgesia on quality of awakening and hemodynamics in patients undergoing laparoscopic gynaecological surgery

目的探讨羟考酮用于妇科腹腔镜手术多模式镇痛对患者苏醒质量及血流动力学的影响。方法选取威海市中心医院2018年9月至2019年3月行腹腔镜卵巢囊肿剔除术患者90例,采用随机数字表法分为观察组、对照组各45例。两组患者均静脉注射氟比洛芬酯(1 mg/kg)行超前镇痛,麻醉方式为静吸复合麻醉,均进行麻醉深度监测;观察组静脉注射羟考酮0.10 mg/kg,对照组静脉注射舒芬太尼5μg。比较两组患者的苏醒质量、血流动力学指标、术后疼痛评分及恶心呕吐发生率。结果观察组呛咳评分[(1.1±0.4)分]低于对照组[(1.7±0.7)分](t=-4.99,P<0.05)、Ramasy评分[(3.6±1.0)分]高于对照组[(2.8±0.8)分](t=7.44,P<0.05)。观察组拔管时(T1)、拔管后5 min(T2)收缩压分别为(117.7±18.2)mmHg、(118.1±16.2)mmHg,均显著低于对照组的(134.2±16.2)mmHg、(134.5±15.2)mmHg(t=-4.54、-4.95,均P<0.05)。两组恶心呕吐发生率差异均无统计学意义(均P>0.05)。观察组术后6 h、术后12 h疼痛评分分别为(2.5±0.8)分、(1.1±0.5)分,均低于对照组的(3.4±0.9)分、(1.9±0.8)分(t=5.01、-5.68,均P<0.05)。结论羟考酮用于妇科腹腔镜手术多模式镇痛,可改善患者的苏醒质量,降低收缩压,减轻术后的疼痛程度,且不增加术后恶心呕吐发生率。

Objective To investigate the effects of oxycodone multimodal analgesia on quality of awakening and hemodynamics in patients undergoing laparoscopic gynaecological surgery.Methods Ninety patients who underwent laparoscopic ovarian cyst removal in Weihai Central Hospital from September 2018 to March 2019 were included in this study.They were randomly divided into observation and control groups,with 45 patients in each group.Both groups were given intravenous flurbiprofen axetil(1 mg/kg)for preemptive analgesia.Combined intravenous and inhalation anesthesia was used.The depth of anesthesia was monitored.The observation group was intravenously given 0.10 mg/kg oxycodone and the control group was intravenously given 5μg sufentanil.Quality of awakening,hemodynamic indexes,postoperative pain score,and incidences of nausea and vomiting were compared between the two groups.Results Cough score in the observation group was significantly lower than that in the control group[(1.1±0.4)points vs.(1.7±0.7)points,t=-4.99,P<0.05].Ramsay Sedation Scale score in the observation group was significantly higher than that in the control group[(3.6±1.0)points vs.(2.8±0.8)points,t=7.44,P<0.05].At 0(T1)and 5 minutes(T2)after extubation,systolic blood pressure in the observation group was(117.7±18.2)mmHg and(118.1±16.2)mmHg,respectively,which were significantly lower than(134.2±16.2)mmHg and(134.5±15.2)mmHg in the control group(t=-4.54,-4.95,both P<0.05).There were no significant differences in the incidences of nausea and vomiting between the two groups(both P>0.05).At 6 and 12 hours after surgery,visual analogue scale score in the observation group was(2.5±0.8)points and(1.1±0.5)points,respectively,which were significantly lower than(3.4±0.9)points and(1.9±0.8)points in the control group(t=5.01,-5.68,both P<0.05).Conclusion Oxycodone multimodal analgesia for laparoscopic gynaecological surgery can improve the quality of awakening,decrease systolic blood pressure,reduce the degree of postoperative pain,and does not increase the incidences of postoperative nausea and vomiting.