羟考酮对老年结直肠癌手术患者术后镇痛效果及谵妄的影响

Effect of Hydroxycodone on Postoperative Analgesia and Delirium in Elderly Patients Undergoing Colorectal Cancer Surgery

目的分析羟考酮对老年结直肠癌手术患者术后镇痛效果及谵妄的影响。方法纳入2021年1月至2022年7月拟在阜阳市人民医院行结直肠癌根治术的94例结直肠癌患者作为观察对象,按照随机信封法将患者分为对照组和试验组,每组47例。对照组采用舒芬太尼镇痛,试验组采用羟考酮镇痛,比较两组术后Ramsay镇静评分和数字评分法(NRS)评分,术后48 h内谵妄发生率和镇痛药物用量以及两组拔管时间、麻醉苏醒时间和不良反应发生率。结果术后各时点间Ramsay镇静评分、NRS评分的主效应差异有统计学意义(P<0.05);不考虑测量时间,两组Ramsay镇静评分、NRS评分的主效应差异有统计学意义(P<0.01);Ramsay镇静评分、NRS评分的时点间与组间存在交互作用(P<0.05或P<0.01),且试验组术后1、3、6 h的Ramsay镇静评分以及术后3、6、12、24、48 h的NRS评分均低于对照组(P<0.05)。试验组谵妄发生率低于对照组[4.26%(2/47)比17.02%(8/47)](χ^(2)=4.029,P=0.045)。试验组拔管时间、麻醉苏醒时间均长于对照组[(20±6)min比(16±6)min、(28±6)min比(24±5)min],术后48 h内镇痛药物用量少于对照组[(62±5)ml比(70±5)ml](P<0.01)。两组不良反应总发生率比较差异无统计学意义(P>0.05)。结论羟考酮对老年结直肠癌手术患者有良好的镇痛及镇静效果,可减少镇痛药物用量,预防谵妄发生,但对术后拔管时间和麻醉苏醒时间有一定影响。

Objective To analyze the effect of hydroxycodone on postoperative analgesia and delirium in elderly patients undergoing colorectal cancer surgery Methods A total of 94 colorectal cancer patients who were scheduled to undergo radical surgery for colorectal cancer at Fuyang People′s Hospital from Jan.2021 to Jul.2022 were included.The patients were randomly divided into a control group and a test group using a random envelope method,with 47 patients in each group.Sufentanil was used for analgesia in the control group,and oxycodone was used for analgesia in the test group.Ramsay sedation score and numerical rating scale(NRS)score after surgery,the incidence of delirium and the amount of analgesic drugs within 48 hours after operation,as well as the time of extubation,the time of anesthesia recovery,and the incidence of adverse reactions of the two groups were compared.Results There were statistical significant differences in the main effect of Ramsay sedation score and NRS score between different time points after surgery(P<0.01).Regardless of the measurement time,there were statistical significant differences in the main effect of Ramsay sedation score and NRS score between the two groups(P<0.05 or P<0.01).There was an interaction between time points and groups in Ramsay sedation score and NRS score(P<0.05).And the Ramsay sedation scores at 1 h,3 h,and 6 h after surgery,as well as the NRS scores at 3 h,6 h,12 h,24 h,and 48 h after surgery in the test group were lower than those in the control group(P<0.05).The incidence of delirium in the test group was lower than that in the control group[4.26%(2/47)vs 17.02%(8/47)](χ^(2)=4.029,P=0.045).The extubation time and anesthesia recovery time of the test group were longer than those of the control group[(20±6)min vs(16±6)min,(28±6)min vs(24±5)min],and the dosage of analgesic drugs within 48 h after operation was less than that of the control group[(62±5)ml vs(70±5)ml](P<0.01).There was no statistical significant difference in the total incidence of adverse reactions between the two groups(P>0.05).Conclusion Hydroxycodone has good analgesic and sedative effects on elderly patients undergoing colorectal cancer surgery,which can reduce the use of analgesics and prevent delirium,although it has a certain impact on postoperative extubation time and anesthesia recovery time.