羟考酮超前镇痛对面肌痉挛微血管减压患者术后疼痛的影响  

Postoperative Analgesic Efficacy of Preemptive Oxycodone in Microvascular Decompression Surgery for Hemifacial Spasm

作　　者：杨蕊 李京生[1] 段庆芳[1] 王天龙[1] YANG Rui;LI Jingsheng;DUAN Qingfang;WANG Tianlong(Department of Anesthesiology and Operating Theater,Xuanwu Hospital,Capital Medical University,Beijing 100053,China)

机构地区：[1]首都医科大学宣武医院麻醉手术科,北京100053

出　　处：《医学综述》2021年第5期1007-1011,共5页Medical Recapitulate

基　　金：北京市“扬帆”计划重点医学专业(ZYLX201818)。

摘　　要：目的观察羟考酮超前镇痛对面肌痉挛微血管减压患者术后疼痛的影响。方法选取2019年5—8月首都医科大学宣武医院功能神经外科收治的43例面肌痉挛病患者为研究对象,采用随机数字法分为舒芬太尼组(23例)和羟考酮组(20例)。舒芬太尼组麻醉诱导静脉注射舒芬太尼0.2μg/kg、依托咪酯0.2 mg/kg和顺苯磺酸阿曲库铵0.15 mg/kg;羟考酮组麻醉诱导静脉注射羟考酮0.2 mg/kg、依托咪酯0.2 mg/kg和顺苯磺酸阿曲库铵0.15 mg/kg。麻醉维持两组均采用丙泊酚和瑞芬太尼持续泵注。关硬脑膜时,舒芬太尼组静脉注射舒芬太尼0.05μg/kg,羟考酮组静脉注射羟考酮0.05 mg/kg。术毕两组患者均连接镇痛泵进行静脉自控镇痛。记录两组患者术后0.5、1、2、4、6、24和48 h的疼痛视觉模拟评分(VAS),记录患者自控镇痛(PCA)按压次数和不良反应发生率。结果羟考酮组术后0.5、1、2、4、6 h VAS评分均显著低于舒芬太尼组[1.0(0.0,3.0)分比3.0(1.5,3.6)分、1.0(0.0,1.8)分比2.0(1.0,3.8)分、1.0(0.0,1.0)分比2.0(1.0,2.5)分、0.5(0.0,1.0)分比1.5(1.0,2.5)分、0.0(0.0,0.8)分比1.0(0.0,2.0)分](P<0.05);两组术后24 h与48 h VAS评分比较差异无统计学意义(P>0.05)。两组术后6、24、48 h PCA按压次数比较差异无统计学意义(P>0.05)。两组患者术后恶心呕吐、头晕、皮肤瘙痒发生率比较差异无统计学意义(P>0.05),且均未发生呼吸抑制及过度镇静。结论与等效剂量的舒芬太尼相比,羟考酮超前镇痛可明显改善面肌痉挛微血管减压患者术后6 h内的疼痛评分,不良反应无明显增加。Objective To investigate the postoperative analgesic efficacy of preemptive oxycodone in microvascular decompression surgery for hemifacial spasm.Methods Forty-three patients undergoing elective microvascular decompression surgery admitted to the Xuanwu Hospital,Capital Medical University from May to Aug.2019 were included and randomized into a sufentanil group(23 cases)and an oxycodone group(20 cases).General anesthesia was induced in the patients using intravenous sufentanil 0.2μg/kg(sufentanil group)or oxycodone 0.2 mg/kg(oxycodone group),etomidate 0.2 mg/kg and cisatracuriumbesylate 0.15 mg/kg.A continuous infusion of propofol and remifentanil was administered to maintain anesthesia in both group.Sufentanil was given intravenously at 0.05μg/kg for those in the sufentanil group,and oxycodone was given intravenously at 0.05 mg/kg for those in the oxycodone group when the endocranium was closed.An electronic pump for patient-controlled intravenous analgesia was connected to the patient at the end of the operation.Visual analogue scale(VAS)scores were recorded at 0.5,1,2,4,6,24 and 48 h following surgery.The compression times of the patient-controlled analgesia(PCA)and analgesia related adverse events incidences were also analyzed.Results The VAS scores at 0.5,1,2,4 and 6 h following surgery in the oxycodone group were significantly lower than those in the sufentanil group[1.0(0.0,3.0)vs 3.0(1.5,3.6),1.0(0.0,1.8)vs 2.0(1.0,3.8),1.0(0.0,1.0)vs 2.0(1.0,2.5),0.5(0.0,1.0)vs 1.5(1.0,2.5),0.0(0.0,0.8)vs 1.0(0.0,2.0)](P<0.05),while VAS scores at 24 h and 48 h following surgery demonstrated no significant differences between the two groups(P>0.05).There were no significant differences in the compression times of PCA at 6 h,24 h and 48 h between the two groups(P>0.05).Similarly,no significant differences were present in the incidence of postoperative nausea&vomiting,dizziness and skin pruritus between the two groups(P>0.05).No patients experienced respiratory depression or excessive sedation.Conclusion Preemptive oxycod

关 键 词：微血管减压术 羟考酮 舒芬太尼 超前镇痛 

分 类 号：R614.24[医药卫生—麻醉学]