盐酸羟考酮在腹腔镜下子宫肌瘤剜除术后镇静镇痛中的应用及对患者疼痛介质水平的影响  

Application of Oxycodone Hydrochloride in Sedation and Analgesia After Laparoscopic Myomectomy and Its Influence on Pain Mediators

作　　者：马媛媛 贺亮 陆富钊 冯华锋 彭凌云[1] MA Yuanyuan(The Affiliated Hospital of Guilin Medical College,Guangxi Guilin 541001,China)

机构地区：[1]桂林医学院附属医院麻醉科,广西桂林541001 [2]南方医科大学第五附属医院麻醉科,广东广州510000

出　　处：《河北医学》2022年第1期159-164,共6页Hebei Medicine

基　　金：广西自然科学基金项目,(编号:2017JJA10724)。

摘　　要：目的:探究盐酸羟考酮(OH)在腹腔镜子宫肌瘤剜除术后镇静、镇痛中的应用效果,分析其对患者疼痛介质的影响。方法:选取2019年5月至2021年5月于本院择期行腹腔镜下子宫肌瘤剜除术的134例患者为对象,采用简单随机法分为三组:OH1组(n=45)、OH2组(n=46)和对照组(n=43)。所有患者术后均采用自控静脉镇痛(PCIA),OH1组PCIA配方为OH 20 mg+昂丹司琼8 mg,OH2组为OH 30mg+昂丹司琼8 mg,对照组为吗啡50 mg+昂丹司琼8 mg。比较各组患者术后6h、12 h和24 h的疼痛情况和镇静程度,比较各组患者麻醉诱导前15 min、术后6 h、12h和24h的疼痛介质水平,记录各组患者术后48h内镇痛补救率、PCA按压次数和不良反应发生情况。结果:观察术后12h、24h,OH1组和OH2组的视觉模拟评分(VAS)和Ramsay评分均明显低于对照组(P<0.05)。术后6h、12h、24h,OH1组和OH2组的前列腺素E2(PGE2)、神经生长因子(NGF)水平均低于对照组(P<0.05)。术后48h内,OH1组和OH2组患者的镇痛补救率均低于对照组,PCA按压次数均少于对照组(P<0.05)。镇痛期间,OH2组患者的恶心呕吐、头晕嗜睡发生率均高于OH1组和对照组(P<0.05)。结论:OH用于腹腔镜下子宫肌瘤剜除术术后镇静、镇痛较吗啡效果好,可有效减轻患者痛觉感受,低剂量OH的不良反应发生率更低,安全性更高。Objective:To explore the application effect of oxycodone hydrochloride(OH)in sedation and analgesia after laparoscopic myomectomy,and analyze its influence on pain mediators.Methods:134 patients who underwent laparoscopic myomectomy in the hospital were selected as the research subjects between May 2019 and May 2021,and were randomly divided into OH1 group(n=45),OH2 Group(n=46)and control group(n=43).All patients were given patient-controlled intravenous analgesia(PCIA)after operation.The OH1 group received PCIA with 20mg of OH and 8mg of ondansetron,the OH2 group received PCIA with 30mg of OH and 8mg of ondansetron,and the control group received PCIA with 50mg of morphine and 8mg of ondansetron.Pain degree,sedative degree,and the levels of pain mediators were compared between the groups.The rescue analgesia rate within 48h after operation,the pressing times of PCA and the occurrence of adverse reactions were recorded.Results:The OH1 group and OH2 group had significantly lower VAS scores and Ramsay scores than the control group at 12h and 24h after operation(P<0.05).The levels of PGE2 and NGF in the OH1 group and the OH2 group at 6h,12h,and 24h after operation were lower than those in the control group(P<0.05).The rescue analgesia rates in the OH1 group and the OH2 group within 48h after operation were lower than those in the control group,and the pressing times of PCA was less than that in the control group(P<0.05).The incidences of nausea and vomiting,dizziness and drowsiness in the OH2 group during analgesia were higher than those in the OH1 group and the control group(P<0.05).Conclusion:Compared with morphine,OH can achieve better sedative and analgesic effects after laparoscopic myomectomy.In addition,low-dose OH has a lower incidence of adverse reactions and is safer.

关 键 词：盐酸羟考酮 子宫肌瘤剜除术 自控静脉镇痛 镇静 疼痛介质 

分 类 号：R737.33[医药卫生—肿瘤] R614[医药卫生—临床医学]