羟考酮用于日间手术麻醉对患者术后苏醒及麻醉并发症的影响

发布时间：2018-01-22 05:14

  本文关键词： 盐酸羟考酮 妇科腹腔镜 术后镇痛　出处：《青岛大学》2017年硕士论文　论文类型：学位论文

【摘要】：目的:探讨盐酸羟考酮注射液对于减少妇科腹腔镜手术术后疼痛的有效性以及安全性,为临床工作提供重要参考,指导临床麻醉用药。方法:经伦理委员会批准及患者知情同意后,选择80例择期全麻下妇科腹腔镜手术患者,年龄20~50岁,ASAⅠ~Ⅱ级。采用随机数字表法,将所有患者分为2组(n=40):盐酸羟考酮注射液组(Oxycodone,O组)和枸橼酸芬太尼注射液组(Fentnyl,F组)。关腹前5min,O组给予静脉注射盐酸羟考酮注射液10mg;F组予静脉注射枸橼酸芬太尼注射液0.1mg。记录拔管时间,拔管后于PACU中观察1小时,评估并记录其拔管后15min、30min及60min的VAS疼痛数字评分和Ramsay镇静评分,观察是否有呼吸抑制等不良反应。术后24小时内按既定时间点(即术后2h、4h、8h、12h和24h)评估并记录患者静息和活动时(咳嗽、翻身或行走)的VAS评分,术后首次VAS≥4分的时间和术后要求追加镇痛的例数并观察术后24小时内有无恶心、呕吐及皮肤瘙痒等不良反应,记录术后肛门排气时间以及评价患者对镇痛的满意度并行舒适度评分(BCS)。结果:两组患者年龄、体重指数、手术时间和术后拔管时间差异无统计学意义(P0.05);拔管后15min、30min、60min VAS疼痛评分和Ramsay镇静评分差异无统计学意义(P0.05),两组均无呼吸抑制情况发生;O组在术后2h、4h和8h的VAS疼痛评分显著低于F组(P0.05),术后12~24小时两组的VAS疼痛评分差异无统计学意义;O组术后首次VAS≥4分的时间比F组明显延长(P0.05),而且术后要求追加镇痛的例数少于F组(P0.05);与F组比较,O组患者术后恶心、呕吐的发生率更低(P0.05);两组患者术后24小时舒适度评分差异无统计学意义(P0.05);与F组比较,O组患者的满意度高,结果有统计学意义(P0.05)。结论:盐酸羟考酮注射液作为唯一的双阿片受体激动剂,用于妇科腹腔镜手术后镇痛效果非常明确,不但能有效减轻妇科微创术后早期疼痛,而且其具有明显针对性的镇痛时效;经临床观察与枸橼酸芬太尼比较,盐酸羟考酮不良反应的发生率也明显降低。
[Abstract]:Objective: to investigate the efficacy and safety of hydroxycodone hydrochloride injection in reducing postoperative pain of gynecological laparoscopic surgery, and to provide important reference for clinical work. Methods: 80 patients with gynecological laparoscopic surgery under general anesthesia were selected after the approval of ethics committee and informed consent. All the patients were divided into two groups by random digital table: Oxycodone hydrochloride injection group. Group O) and fentanyl citrate injection group (group F). In group F, 0.1 mg fentanyl citrate injection was injected intravenously. The extubation time was recorded and observed in PACU for 1 hour after extubation. The results were evaluated and recorded 15 minutes after extubation. The scores of VAS pain number and Ramsay sedation were measured at 30min and 60min, and the adverse reactions such as respiratory inhibition were observed. VAS scores of rest and activity (coughing, turning over or walking) were assessed and recorded at 4 h, 8 h, 12 h and 24 h. The time of the first postoperative VAS 鈮，

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