羟考酮递减法背景输注在老年全髋人工关节置换术后镇痛中的应用效果  

Effect of oxycodone successive subtraction method background infusion for postoperative analgesia in old patients undergoing total hip arthroplasty

作　　者：胡惠英 李书庭 罗紫苏 李斌 吴坛光 汪婷婷 任立文 孙巧玲 HU Hui-ying;LI Shu-ting;Luo Zi-su(Anesthesiology Department of Central Theater Command General Hospital,Wuhan 430010,China)

机构地区：[1]中部战区总医院麻醉科,武汉430010 [2]湖北医药学院第一临床学院,十堰442000

出　　处：《中国中西医结合外科杂志》2024年第5期702-706,共5页Chinese Journal of Surgery of Integrated Traditional and Western Medicine

基　　金：中部战区总医院卫生战备专项课题(ZZ2021ZB08)。

摘　　要：目的:观察羟考酮递减法背景输注在老年全髋人工关节置换术(THA)后镇痛中的应用效果。方法:选择2020年4月—2023年9月在我院择期行THA的患者90例,男33例,女57例;ASA分级Ⅰ~Ⅱ级,年龄62~78岁,体质量48~78 kg。采用随机数字表法,将90例患者分为3组(n=30),S组术后静脉自控镇痛给予舒芬太尼2.0μg/kg+托烷司琼10 mg+0.9%生理盐水至100 mL,Q_(1)组和Q_(2)组术后静脉自控镇痛给予羟考酮0.20 mg/kg+托烷司琼10 mg+0.9%生理盐水至100 mL。S组和Q_(1)组患者镇痛参数均为背景输注速率2 mL/h,Q_(2)组患者镇痛参数第1个12 h为背景输注速率2 mL/h,之后每隔12 h减20%,自控镇痛(PCA)量2 mL,锁定时间10 min。比较三组术毕(T_(1))、术后2 h(T_(2))、6 h(T_(3))、12 h(T_(4))、24 h(T_(5))、48 h(T_(6))的VAS评分,Ramsay镇静评分,术后48 h内有效按压次数、药物使用总量,记录并比较三组的呼吸抑制、恶心、呕吐和皮肤瘙痒等不良反应。结果:S组T_(2)-T_(4)时VAS评分高于Q_(1)组和Q_(2)组(P<0.05),S组T_(2)-T_(4)时Ramsay镇静评分高于Q_(1)组和Q_(2)组(P<0.05),Q_(1)组和Q_(2)组患者PCA按压次数、药物总使用量均低于S组(P<0.05);Q_(2)组48 h用药总量低于Q_(1)和S组(P<0.05);Q_(2)组术后恶心呕吐发生率低于S组(P<0.05)。结论:老年患者行THA术后应用羟考酮注射液递减法背景输注能获得满意的镇痛效果,减少了药物用量,并降低了不良反应发生率。Objective To observe the effect of oxycodone successive subtraction method background infusion for postoperative analgesia in old patients undergoing total hip arthroplasty.Methods ninety patients undergoing total hip arthroplasty,from April 2020 to September 2023.33 males,57 females,aged 62~78 years,falling into ASA physical statusⅠorⅡ,were randomly decided into the group Q_(1)(n=30),the group Q_(2)(n=30),and the group E(n=30).The patients in group S recieved sufentayl 2.0μg/kg+tropisetron 10 mg+0.9%normal saline to 100 mL.The patients in group Q_(1)and group Q_(2)received hydromorphone 0.20 mg/kg+tropisetron 10 mg+0.9%normal saline to 100 mL.The analgesic parameters of group S and group Q_(1)were background infusion rate of 2 mL/h,PCA amount of 2 mL,and lock-up time of 10 min.The analgesic parameters on the first 12 h after operation of group Q_(2)were background infusion rate of 2 mL/h,every 12 h later,the background infusion decreased by 20%,PCA amount of 2 mL,and lock-up time of 10 min.Recorded the VAS scores of the three groups the VAS scorses at 2 h,6 h,12 h and 24 h after surgery and the effective compression of PCIA,the amount of drug use within 48 hours points after surgery,Ramsay sedation scores,and adverse reactions such as respiratory depression,nausea,vomiting,itching.Results The VAS score in group S T_(2)-T_(4)were higher than those in group Q_(1)and group Q_(2)(P<0.05).Ramsay sedation score in group S T_(2)-T_(4)were lower than those in group Q_(1)and group Q_(2)(P<0.05).The effective compression frequency and the volume of drug use of group Q_(1)and group Q_(2)within 48 hours were lower than that in group S(P<0.05).The volume of drug use and postoperative nausea and vomiting in group Q_(2)were higher than that in group Q_(1)(P<0.05).Conclusion Oxycodone successive subtraction method background infusion for postoperative analgesia in old patients undergoing total hip arthroplasty can obtain satisfactory analgesia effect,reduce the dosage of drugs and reduce the adverse reaction.

关 键 词：羟考酮 老年 全髋人工关节置换 递减法 镇痛 

分 类 号：R614.27[医药卫生—麻醉学]