羟考酮不同给药时间对胸科术后早期镇痛的影响  

Effects of Oxycodone Different Administration Time on Early Postoperative Analgesia in Thoracic Surgery

作　　者：王美青[1] 赵维珊[1] 雷钧[1] 殷飞[1] 孙杨[1] 

机构地区：[1]南京市胸科医院麻醉科,江苏南京210029

出　　处：《继续医学教育》2016年第12期149-150,共2页Continuing Medical Education

摘　　要：目的探讨羟考酮不同给药时间对胸科术后早期疼痛和不良反应的影响。方法选择择期胸科手术60例,随机分为术前组(P组)和术中组(I组),每组30例。P组于切皮前静脉注射0.1 mg/kg羟考酮,I组手术结束前20 min静脉注射0.1 mg/kg羟考酮。观察两组患者术后苏醒时间、拔管时间、拔管后5 min(T_1)、2 h(T_2)、4 h(T_3)的VAS评分及Ramsay镇静评分,及拔管后15 min动脉血气、术后躁动、嗜睡及恶心呕吐的发生率。结果与I组比较,P组术后苏醒时间和拔管时间缩短,拔管后5 min,2 h VAS评分差异无统计学意义(P>0.05),4 h VAS评分较高。拔管后5 min Ramsay镇静评分降低,且术后嗜睡发生率降低。拔管后15 min Pa O_2和PaCO_2比较差异无统计学意义。术后躁动及恶心呕吐发生率差异无统计学意义(P>0.05)。结论羟考酮用于胸科术后早期镇痛效果确切,切皮前给药患者术后苏醒和拔管时间缩短,且清醒镇痛,不增加术后不良反应发生率。但对于手术时间较长的患者,应适时追加镇痛药,并注意个体化用药。Objective To investigate the postoperative early pain and adverse reaction of oxycodone administered at different time on patients undergoing thoracic surgery. Methods 60 patients （ASA I-II） undergoing selective thoracic surgery were randomly divided into preoperation group （group P） and intraoperation group （group I）, 30 patients in each group. 0.1 mg/kg oxycodone were administered through intravenous injection before skin incision in group I and the same dose were injected for 20min before the end of surgery. Recovery time after anesthesia, extubation time, the VAS score and Ramsay sedation score at 5 rain, 2 h, and 4 h after extubation were observed in two groups. Meanwhile, arterial blood gas after extubation for 15 min, as well as, the incidence of postoperative agitation, sleepiness, and postoperative nausea and vomiting （PONV） were recorded. Results Compared with group I, group P postoperative recovery time and extubation time were shortened, the VAS score after extubation at 5 min, 2 h was not statistically significant, the VAS score at 4 h was higher. After extubation, the Ramsay sedation score and the incidence of postoperative sleepiness at 5 min were reduced. There was no significant difference in the incidence of postoperative agitation and PONV, as well as, in the comparation of PaO2 and PaCO2 at 15 rain after extubation. Conclusion Oxycodone used in thorax postoperative before skin incision has obvious early analgesic effect, and conscious-sedation. Postoperative revival and extubation time significantly shortened, the incidence of postoperative adverse reactions has no obvious difference. But for patients with surgery for a considerable time, should be received timely additional analgesics, and pay attention to the individualized medication.

关 键 词：胸科手术 羟考酮 术后早期镇痛 

分 类 号：R971.2[医药卫生—药品]