摘要
目的观察羟考酮无背景剂量输注模式在剖宫产术后患者自控静脉镇痛（patient-controlled intravenous analgesia，PCIA）中的应用效果。方法择期行剖宫产术的患者60例，ASA分级Ⅰ、Ⅱ级，年龄22～36岁，按随机数字表法分为两组（每组30例）：吗啡组（M组）和羟考酮组（O组）。镇痛泵配方：M组，100ml生理盐水中含吗啡50mg和昂丹司琼8mg；0组，100ml生理盐水中含羟考酮50mg和昂丹司琼8mg。两组均无背景剂量，患者自控镇痛（patient controlled analgesia，PCA）4ml，单次剂量2mg，锁定时间5min。于术后4、8、12、24、48h行静态VAS评分、动态VAS评分及宫缩VAS评分，记录术后48h镇痛药用量及PCA按压次数，并观察术后恶心呕吐副作用发生情况和患者满意度情况。结果两组患者术后4、8、12、24、48h静态VAS评分、动态VAS评分差异无统计学意义（P〉0．05），术后4、8、12、24hO组宫缩VAS评分明显低于M组（P〈0．05），术后48h两组患者宫缩VAS评分差异无统计学意义（P〉0．05）。O组术后48h镇痛药总用量、PCA按压次数及术后恶心呕吐、皮肤瘙痒发生率低于M组（P〈0．05）。0组患者满意度明显高于M组（P〈0．05）。结论实施无背景剂量PCIA，羟考酮与吗啡均可以有效降低剖宫产术后疼痛，对于宫缩痛，羟考酮有更佳效果，患者满意度更高。
Objective To observe the efficacy of oxycodone under no background dose in patient-controlled intravenous analgesia （PCIA） after caesarean surgery. Methods Sixty patients undergoing selective cesarean section were randomly categorized into two groups using random schedule table（n=30）： group morphine（group M） and group oxycodone（group O）, all patients were aged between 20 to 35 years and of ASA class Ⅰ, Ⅱ. Fifty milligrams of morphine was delivered in group M, while 50 mg oxycodone was delivered in group O. Ondansetron 8 mg was added to each group. PCIA was set on demand mode without loading dose or background infusion. In both groups, drugs were diluted to 100 ml with normal saline, and 4 ml bolus dose with 5 min lockout interval was set. At 4, 8, 12 h and 48 h after surgery, VAS was assessed, including VAS at rest, VAS at motion and VAS at uterine contraction. Total doses of the drug delivery within postoperative 48 h and the number of patient controlled analgesia（PCA） were recorded, postoperative nausea and vomiting and patient satisfaction were also evaluated. Results At 4, 8, 12 h and 24 h after surgery, VAS at uterine contraction in group O was significantly lower than VAS of group M（P〈0.05）. No significant differences were detected between the two groups in VAS at rest and motion at all time points（P〉0.05）. At 48 h after surgery, total doses of PCIA drugs, the number of PCA and the incidences of side effects were significantly lower in group O than these parameters in group M （P〈0.05）. The overall patient satisfaction degree in group O was significantly higher than patient satisfaction degree in group O （P〈0.05）. Conclusions Both oxycodone and morphine are effective for pain relief after cesarean section when PCIA is set on bolus mode. However, compared with morphine, oxycodone exhibited significantly better effects on uterine contraction, pain relief and patient satisfaction.
作者
余健
刘清仁
陈晶晶
李祥
王亚军
Yu Jian;Liu Qingren;Chen Jinxing;Li Xiang;Wang Yajun(Department of Anesthesiology, Xishan People＇s Hospital of Wuxi, Wuxi 214011, China)
出处
《国际麻醉学与复苏杂志》
CAS
2018年第4期325-327,332,共4页
International Journal of Anesthesiology and Resuscitation
关键词
剖宫产术
术后镇痛
羟考酮
患者自控静脉镇痛
Caesarean section
Postoperative analgesia
Oxycodone
Patient-controlled intravenous analgesia
