羟考酮递减法背景输注在胸腔镜肺叶切除患者术后镇痛中的临床效果观察*

Clinical observation of oxycodone hydrochloride injection successive subtraction method background infusion for postoperative analgesia in patients of lobectomy under thoracoscope*

摘要:

目的??评价盐酸羟考酮注射液递减法背景输注在胸腔镜下肺叶切除患者术后镇痛的临床效果。方法 90例胸腔镜下肺叶切除患者，采用随机数字表法将患者随机分为舒芬太尼组（S组）、恒速羟考酮输注组（Q1组）和递减法背景输注羟考酮组（Q2组），每组30例。手术结束前10 min，S组给予舒芬太尼0.10μg/kg，Q1、Q2组给予羟考酮0.10 mg/kg，S组接电子泵舒芬太尼2.00μg/kg（100 ml），背景输注0.03μg/（kg?h），患者自控镇痛（PCA）剂量0.015μg/kg；Q1组羟考酮1.00 mg/kg（100 ml），背景剂量15.00μg/（kg?h），PCA剂量15.00μg/kg；Q2组羟考酮1.00 mg/kg（100 ml）术后第1个12 h背景输注15.00μg/（kg?h），之后每隔12 h减20.00%，PCA剂量15.00μg/kg，所有镇痛泵锁定时间10 min，每小时锁定4次。记录患者手术结束（T0）、拔管时（T1）和拔管后5 min（T2）有流动力学情况，同时记录患者术后2 h（T3）、8 h（T4）、12 h（T5）、24 h（T6）、48 h（T7）的静态数字疼痛评分（NRS）[NRS（R）]，NRS（M）（动态NRS评分），Ramsay评分（镇静水平），PCA（次），药物补救次数，药物使用总量，呼吸抑制、恶心、呕吐和皮肤瘙痒等不良反应和患者术后镇痛的满意度。结果 3组患者拔管时平均动脉压（MAP）和心率（HR）均有升高，与手术结束时比较差异有统计学意义（P <0.05），3组患者手术结束时、拔管时和拔管后5 min MAP和HR组间比较差异无统计学意义（P >0.05）；Q1、Q2组术后NRS（R）评分在（T3～5）时点低于S组，NRS（M）评分在（T3～6）时点低于S组（P <0.05）；Q1、Q2组Ramsay评分在（T3～7）时点高于S组（P <0.05）；Q1、Q2组患者PCA按压次数、补救药物使用次数、第1和2天睡眠打搅次数均低于S组；Q2组48 h用药总量低于Q1和S组（P <0.05）；术后恶心呕吐Q2组低于S组（P <0.05）；术后镇痛患者满意度Q1、Q2组高于S组（P <0.05）。结论 胸腔镜下肺叶切除患者术后应用羟考酮注射液递减法背景输注能获得满意的镇痛效果，麻醉苏醒平稳，镇痛效果满意，减少了药物用量和降低了不良反应。

Abstract:

Objective?To observe the analgesia effect of oxycodone hydrochloride injection successive subtraction method background infusion on postoperative analgesia in patients of lobectomy under thoracoscope.?Methods?Ninety lobectomy under thoracoscope patients, using the random number table method patients were randomly divided into three groups:sufentanil group (group S), the constant speed oxycodone infusion group (Q1) and the decreasing background infusion oxycodone group (Q2), 30 cases in each group. On the time of 10 minutes before the end of surgery, S group was given sufentanil 0.10 μg/kg, Q1 and Q2 group was given oxycodone 0.10 mg/kg, each patient was given intravenous patient-controlled analgesia (PCIA), the group of S set electronic pump sufentanil 2.00 μg/kg (100 ml), background infusion was 0.03 μg/(kg?h), PCA dose was 0.015 μg/kg; The group of Q1 was oxycodone 1.00 mg/kg (100 ml), background dose of 15.00 μg/(kg?h), PCA dose of 15.0 μg/kg; The group of Q2 also was oxycodone 1.00 mg/kg (100 ml), on the first 12 h after operation, the background infusion was 15.00 μg/(kg?h), every 12 h later, the background infusion decreased by 20%, PCA dose was 15.00 μg/kg, all of the pump locking time was 10 minutes, lock 4 times per hour. Recorded the number of hemodynamic on the end of operation, immediate extubation and extubation after 5 minutes. On the time of postoperative 2 h, 8 h, 12 h, 24 h, 48 h, recorded the scores of NRS(R), NRS (M), Ramsay. Recorded the times of PCA compression,times of medicaments remedies,the amount of drug use, adverse reactions such as respiratory depression, nausea, vomiting, itching and satisfaction of patients to postoperative analgesia.?Results?The MAP and HR of three groups of patients were increased in the time of tube drawing (P < 0.05), there was no significantly difference in MAP and HR among the three groups at the end of operation, immediate extubation and after 5 minutes of extubation (P > 0.05). The score of NRS (R) in the groups of Q1 and Q2 was lower than group S at the time of (T3~5) (P < 0.05), the score of NRS (M) in the groups of Q1 and Q2 was lower than group S at the time of (T3~6) also. The Ramsay score of Q1 and Q2 group was higher than the group S in the point (T3~7). Which the times of PCA and remedial drug use, sleep disturbed times in the first day and second day of group Q1 and Q2 was lower than the group S (P < 0.05). The volume of drug use at 48 h in the group of Q2 was lower than the group Q1 and S (P < 0.05). Postoperative nausea and vomiting of group Q2 was lowered than group S (P < 0.05). The satisfaction of Patients to postoperative analgesia in the group Q2 and Q1 was higher than group S (P < 0.05).?Conclusion?Lobectomy under thoracoscope patients with postoperative application of successive subtraction method background infusion oxycodone can obtain satisfactory analgesia effect with a smooth anesthesia recovery period, satisfied analgesic effect, reduce the dosage of drugs and reduce the adverse reaction.