盐酸羟考酮在老年经皮椎体后凸成形术镇痛管理中的应用  

Application of oxycodone hydrochloride for intraoperative analgesia in elderly patients undergoing percutaneous kyphoplasty

作　　者：丁可 曹媛媛 葛德高 鲍红光[1] 陈利海[1] DING Ke;CAO Yuanyuan;GE Degao;BAO Hongguang;CHEN Lihai(Department of Anesthesiology,Nanjing First Hospital,Nanjing Medical University,Nanjing 210006,Jiangsu,China)

机构地区：[1]南京医科大学附属南京医院(南京市第一医院)麻醉科,江苏南京210006

出　　处：《上海医学》2021年第2期91-94,共4页Shanghai Medical Journal

基　　金：“六大人才高峰”高层次人才选拔培养资助项目(YY-104)。

摘　　要：目的评估盐酸羟考酮用于老年患者经皮椎体后凸成形术(percutaneous kyphoplasty,PKP)的麻醉效果,观察其半数有效量(median effective dose,ED 50)。方法选取2019年4—10月在南京市第一医院行PKP并符合纳入标准的老年患者23例。术中采用Dixon序贯法计算静脉注射盐酸羟考酮用量,即羟考酮首剂量为0.1 mg/kg,若上一例患者镇痛效果满意,则下一例患者剂量减少0.005 mg/kg;若上一例患者镇痛效果不满意,则下一例患者剂量增加0.005 mg/kg。疼痛数字评分法(NRS)评分≤3分为镇痛有效,疼痛NRS评分≥4分为镇痛无效。记录患者呼吸循环参数与不良反应发生情况。结果根据患者疼痛NRS评分结果,将14例术中镇痛有效者纳入有效组,余9例纳入无效组。盐酸羟考酮的使用剂量范围为0.065~0.100 mg/kg,术中镇痛的ED 50为0.075 mg/kg(95%CI为0.60~0.82 mg/kg)。用药剂量为0.090~0.100 mg/kg时,镇痛有效率为100.00%;0.065 mg/kg时,镇痛有效率为0。在T 2至T 4时间点,有效组的疼痛NRS评分显著低于无效组(P值均<0.05)。有效组麻醉效果、患者和手术医师满意度的评分均显著高于无效组(P值均<0.01)。有效组和无效组术中各有2例患者发生恶心、呕吐,均为女性患者。无效组术中有1例患者出现高血压,予乌拉地尔10 mg静脉注射后血压逐渐恢复至正常。两组术中均未发生明显的呼吸抑制、循环抑制,以及过度镇静等不良反应。结论盐酸羟考酮镇痛效果确切,恶心、呕吐发生率低,对呼吸和循环系统影响小,适用于老年患者PKP的镇痛管理。Objective To evaluate the anesthetic effect and median effective dose(ED 50)of oxycodone in elderly patients undergoing percutaneous kyphoplasty(PKP).Methods Twenty-three elderly patients who underwent PKP between April 2019 and October 2019 and met the inclusion criteria were selected for this study.The dose of oxycodone was determined by Dixon up-and-down method.If the previous patient had satisfactory analgesic effect,the next patient’s dose was reduced by 0.005 mg/kg.If the previous patient's analgesic effect was not satisfactory,the next dose was increased by 0.005 mg/kg.NRS pain score≤3 was considered as effective for analgesia,otherwise it was considered as ineffective for analgesia.The respiratory and circulatory parameters and adverse effects were recorded.Results The analgesia was effective in 14 patients and ineffective in 9 patients according the NRS pain score.The dose of oxycodone ranged from 0.065 to 0.100 mg/kg,and ED 50 was 0.075 mg/kg(95%CI:0.60-0.82 mg/kg).The effective rate of analgesia was 100.00%when the dose of oxycodone was 0.090-0.100 mg/kg,while it was zero when the dose was 0.065 mg/kg.The pain NRS score in effective analgesia group was significantly lower than that in ineffective analgesia group at T 2-T 4(all P<0.05).The effective analgesia group achieved more obvious anesthetic effect and higher degree of satisfaction in both patients and surgeons than ineffective analgesia group(all P<0.01).Nausea and vomiting occurred in two female patients in each group.Hypertension was found in one patient in the ineffective analgesia group,which was treated by intravenous injection of 10 mg urapidil.There was no obvious respiratory suppression,circulatory suppression or excessive sedation.Conclusion Oxycodone hydrochloride is suitable for analgesia in elderly patients undergoing PKP.It has exact analgesic effect,low incidence of nausea and vomiting and less impact on respiratory and circulatory systems.

关 键 词：盐酸羟考酮 经皮椎体后凸成形术 老年患者 半数有效量 镇痛 

分 类 号：R614[医药卫生—麻醉学]