羟考酮与芬太尼用于腹腔镜子宫切除术后的镇痛、镇静效果和安全性比较
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篇名: 羟考酮与芬太尼用于腹腔镜子宫切除术后的镇痛、镇静效果和安全性比较
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摘要: 目 的:比较羟考酮与芬太尼用于腹腔镜子宫切除术后的镇痛、镇静效果和安全性。 方法:选择2015年8月-2017年4月113例择期行腹腔镜子宫切除术患者,按随机数字表法分为羟考酮组(58例)和芬太尼组(55例)。羟考酮组患者于缝皮前静脉注射盐酸羟考酮注射液0.07 mg/kg,芬太尼组患者于缝皮前静脉注射枸橼酸芬太尼注射液0.7 μg/kg。待患者清醒后分别使用相应药物静脉自控镇痛。观察两组患者麻醉诱导前(T0)、拔管即刻(T1)、拔管后5 min(T2)时的心率(HR)、中心静脉压(CVP)、平均动脉压(MAP)、氧分压[p(O2)],术后1 h(T3)、6 h(T4)、12 h(T5)、24 h(T6)、48 h(T7)时的视觉模拟评分法(VAS)评分和Ramsay镇静评分,T0、T3、T6、T7时的血清P物质和五羟色胺(5-HT)水平,并记录不良反应发生情况。结果: T1、T2时,两组患者 HR、MAP显著高于同组T0时,但羟考酮组显著低于芬太尼组,差异均有统计学意义(P<0.05);两组患者不同时间点的CVP、p(O2)比较,差异均无统计学意义(P>0.05)。T3~T6时,羟考酮组患者VAS评分均显著低于芬太尼组,差异均有统计学意义(P<0.05);两组患者T7时VAS评分及T3~T7时Ramsay镇静评分比较,差异均无统计学意义(P>0.05)。T3、T6、T7时,两组患者血清P物质和5-HT水平均显著高于同组T0时,但T3、T6时羟考酮组均显著低于芬太尼组,差异均有统计学意义(P<0.05);T7时,两组患者血清P物质和5-HT水平比较,差异均无统计学意义(P>0.05)。羟考酮组患者不良反应总发生率(12.1%)显著低于芬太尼组(27.3%),差异有统计学意义(P<0.05)。结论:羟考酮用于腹腔镜子宫切除术患者在维持拔管前血流动力学稳定、术后早期降低血清致痛物质水平、早期镇痛效果及安全性方面均优于芬太尼,镇静效果与芬太尼相当。
ABSTRACT: OBJECTIVE: To compare the analgesia, sedative effect and safety of oxycodone and fentanyl after laparoscopic hysterectomy. METHODS: A total of 113 patients underwent selective laparoscopic hysterectomy during Aug. 2015-Apr. 2017 were selected and divided into oxycodone group (58 cases) and fentanyl group (55 cases) according to random number table. Oxycodone group received 0.07 mg/kg Oxycodone hydrochloride injection intravenously before skin suture. Fentanyl group received 0.7 μg/kg Fentanyl citrate injection intravenously before skin suture. The patients were given relevant drugs for patient-controlled intravenous analgesia after they woke up. Hear rate (HR), central venous pressure (CVP), mean arterial pressure (MAP) and oxygen partial pressure [p(O2)] were observed in 2 groups before analgesia induction (T0), at the moment of extubation (T1), 5 min after extubation(T2). VAS score and Ramsay sedation score were observed 1 h(T3), 6 h(T4), 12 h(T5), 24 h(T6), 48 h(T7) after surgery. The levels of serum P substance and 5-HT were observed before analgesia induction (T0), 1 h(T3), 6 h(T4), 12 h(T5), 24 h(T6), 48 h(T7) after surgery. The occurrence of ADR were recorded. RESULTS: At T1 and T2, HR and MAP of 2 groups were significantly higher than at T0, and oxycodone group was significantly lower than fentanyl group, with statistical significance (P<0.05); there was no statistical significance in the levels of CVP or p(O2) between 2 groups at different time points (P>0.05). At T3-T6, VAS score of oxycodone group was significantly lower than that of fentanyl group, with statistical significance (P<0.05). There was no statistical significance in VAS score at T7 or Ramsay score at T3-T7 between 2 groups (P>0.05). The levels of serum P substance and 5-HT in 2 groups at T3, T6 and T7 were significantly higher than at T0; at T3, T6, the oxycodone group were significantly lower than the fentanyl group, with statistical significance (P<0.05). At T7, there was no statistical significance in the levels of serum P substance and 5-HT between 2 groups (P>0.05). Total incidence of ADR in oxycodone group  (12.1%) was significantly lower than fentanyl group (27.3%), with statistical significance (P<0.05). CONCLUSIONS: Oxycodone is better than fentanyl in maintaining hemodynamic stability, early reducing the serum levels of pain-induced substances, early analgesic effects for patients underwent laparoscopic hysterectomy, but sedative effect of them are similar.
期刊: 2018年第29卷第8期
作者: 黄科,樊梅,周科耀,彰宁
AUTHORS: HUANG Ke,FAN Mei,ZHOU Keyao,ZHANG Ning
关键字: 羟考酮;芬太尼;腹腔镜;子宫切除术;术后镇痛;镇静;安全性
KEYWORDS: Oxycodone; Fentanyl; Laparoscope; Hysterectomy; Postoperative analgesia; Sedation; Safety
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