羟考酮用于髋关节置换术后老年病人自控静脉镇痛的效果  

Efficacy of oxycodone for patient-controlled intravenous analgesia after hip arthroplasty in elderly patients

作　　者：胡小兰[1] 代青青 梁应平[1] 蔡俊赢[1] 胡衍辉[1] 徐国海[1] 

机构地区：[1]南昌大学第二附属医院麻醉科,330006

出　　处：《中华麻醉学杂志》2016年第10期1229-1231,共3页Chinese Journal of Anesthesiology

摘　　要：目的评价羟考酮用于髋关节置换术后老年病人自控静脉镇痛的效果。方法择期全麻下行单侧髋关节置换术的老年病人60例，年龄65～85岁，体重42～89kg，性别不限，ASA分级Ⅰ或Ⅱ级，采用随机数字表法分为2组（n=30）：吗啡组（M组）和羟考酮组（O组）。麻醉诱导前30min静脉注射帕瑞昔布钠40mg，常规麻醉诱导和麻醉维持。缝皮时连接自控静脉镇痛泵，镇痛药液配方：M组吗啡0．6mg／kg＋托烷司琼10mg，0组羟考酮0．6mg／kg＋托烷司琼10mg，均用生理盐水稀释至100ml，背景输注速率2ml／h，PCA剂量为0．5ml，锁定时间为15min，维持VAS评分≤3分，镇痛至术后48h；当VAS评分≥4时肌肉注射哌替啶50mg。记录补救镇痛药物使用情况以及不良反应的发生情况。结果M组补救镇痛率为10％，O组无一例病人进行补救镇痛；与M组比较，O组补救镇痛率、恶心呕吐及皮肤瘙痒发生率降低（P〈0．05）。结论羟考酮用于髋关节置换术后老年病人自控静脉镇痛效果良好，不良反应少，提示羟考酮对重度躯体痛具有良好的镇痛效果。Objective To evaluate the efficacy of oxycodone for patient-controlled intravenous anal- gesia （PCIA） after hip art hroplasty in elderly patients. Methods Sixty patients of both sexes, aged 65-85 yr, weighing 42-89 kg, Of American Society of Anesthesiologists physical status Ⅰ or Ⅱ, scheduled for elective unilateral hip arthroplasty under general anesthesia, were divided into 2 groups （n = 30 each） using a random number table： morphine group （ group M） and oxycodone group （ group O）. Parecoxib sodium 40 mg was injected intravenously at 30 min before induction of anesthesia, followed by induction and mainte- nance of anesthesia. PCIA pump was connected at the beginning of skin closure. PCIA solution contained morphine 0. 6 mg/kg and tropisetron 10 mg diluted to 100 ml in normal saline in group M and oxycodone 0. 6 mg/kg and tropisetron 10 mg diluted to 100 ml in normal saline in group O. The PCA pump was set up with a background infusion at 2 ml/h, a 0. 5 ml bolus dose and a 15 min lockout interval in both groups. Visual analogue scale score was .maintained ≤ 3, and postoperative analgesia lasted until 48 h after operation. When analogue scale score ≥ 4, pethidine 50 mg/kg was injected muscularly as rescue analgesic. The re- quirement for rescue analgesic and occurrence of adverse effects were recorded. Results Ten percent pa- tients required rescue analgesics in group M, and no patients required rescue analgesics in group O. Com- pared with group M, the requirement for rescue analgesics and incidence of nausea, vomiting and pruritus were significantly decreased in group O （P〈0. 05）. Conclusion Oxyeodone provides reliable efficacy for PCIA after hip arthroplasty in elderly patients with fewer adverse effects, indicating that oxyeodone produces good analgesic efficacy for severe somatalgia.

关 键 词：羟可酮 疼痛 手术后 镇痛  病人控制 老年人 关节成形术 置换 髋 

分 类 号：R614[医药卫生—麻醉学]