羟考酮对胸腔镜手术患者术后急性疼痛的影响  

The effect of oxycodone on postoperative acute pain in patients undergoing thoracoscopic surgery

作　　者：丁锐炀 宋宗斌[1] 刘卓懿 翟振平[1] 程智刚[1] 郭曲练[1] Ding Ruiyang;Song Zongbin;Liu Zhuoyi;Zhai Zhenping;Cheng Zhigang;Guo Qulian(Department of Anesthesiology,Xiangya Hospital,Central South University,Changsha 410008,China)

机构地区：[1]中南大学湘雅医院麻醉科,长沙410008

出　　处：《中国医师杂志》2023年第11期1610-1614,共5页Journal of Chinese Physician

基　　金：湖南省自然科学基金(2022JJ30956,2021JJ31055);国家老年疾病临床医学研究中心临床研究基金(2021LNJJ14)。

摘　　要：目的回顾性观察羟考酮对于胸腔镜手术患者术后急性疼痛的作用。方法回顾性分析2020年4月1日至2021年9月30日在中南大学湘雅医院静吸复合全身麻醉下行胸腔镜下胸科手术的404例患者的临床资料,依据术中是否使用羟考酮分为A组(n=99,羟考酮组)和B组(n=305,对照组),进一步采用最近邻配比法将两组患者1∶1匹配。比较两组患者术后24 h的活动及静息疼痛视觉模拟评分(VAS)及中重度疼痛发生率,观察恶心、呕吐、瘙痒、眩晕等镇痛相关不良反应的发生率及严重程度。结果两组患者倾向性评分匹配后均衡性好(SMD<0.20),两组间年龄、性别、体重指数、ASA分级、手术时间、术中出血量、围手术期止呕药和镇痛药的使用情况差异无统计学意义(均P>0.05)。与对照组相比,A组患者静息VAS[(2.03±1.61)分vs(1.62±1.31)分,P=0.049]和活动VAS[(4.13±1.72)分vs(3.51±1.79)分,P=0.013]均更低,且在活动时中重度疼痛(VAS≥4)的发生率更低[59.6%(59/99)vs 37.4%(37/99),P=0.003]。两组间镇痛相关不良反应发生率的差异无统计学意义(P>0.05)。结论静脉注射羟考酮可以有效减轻胸腔镜手术患者术后24 h内急性疼痛,降低患者活动时中重度疼痛的发生率。Objective To retrospectively observe the effect of oxycodone on acute postoperative pain in patients undergoing thoracoscopic surgery.Methods A retrospective analysis was conducted on the clinical data of 404 patients undergoing thoracoscopic thoracic surgery under combined general anesthesia at the Xiangya Hospital,Central South University from April 1,2020 to September 30,2021.They were divided into A group(n=99,oxycodone group)and B group(n=305,control group)based on whether oxycodone was used during the surgery.The two groups of patients were further matched 1∶1 using the nearest neighbor matching method.We compared the Visual Analogue Scale(VAS)of activity and resting pain and the incidence of moderate to severe pain between two groups of patients 24 hours after surgery,and observed the incidence and severity of pain related adverse reactions such as nausea,vomiting,itching,and dizziness.Resultsl After matching the propensity scores of the two groups of patients,the balance was good(SMD<0.20).There was no statistically significant difference between the groups in age,gender,body mass index,American Society of Anesthesiologist(ASA)grade,surgical time,intraoperative bleeding,and the use of antiemetics and analgesics during the perioperative period(all P>0.05).Compared with the control group,patients in the group A had a resting VAS[(2.03±1.61)points vs(1.62±1.31)points,P=0.049],and activity VAS[(4.13±1.72)points vs(3.51±1.79)points,P=0.013]was even lower,and the incidence of moderate to severe pain(VAS≥4)during activity was lower[59.6%(59/99)vs 37.4%(37/99),P=0.003].There was no statistically significant difference in the incidence of analgesic related adverse reactions between the two groups(P>0.05).Conclusions Intravenous injection of oxycodone can effectively alleviate acute pain in patients undergoing thoracoscopic surgery within 24 hours,and reduce the incidence of moderate to severe pain during activity.

关 键 词：胸腔镜检查 疼痛 手术后 羟考酮 

分 类 号：R614[医药卫生—麻醉学]