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[1]王青,周斌,张韬,等.分时段递减输注羟考酮在肝癌切除患者术后镇痛的应用[J].医学研究与战创伤救治(原医学研究生学报),2020,22(6):597-602.[doi:10.3969/j.issn.1672-271X.2020.06.009]
　WANG Qing,ZHOU Bin,ZHANG Tao,et al.Application of the time-scheduled decremental infusion of oxycodone for postoperative patient-controlled analgesia after liver cancer resection[J].JOURNAL OF MEDICALRESEARCH —COMBAT TRAUMA CARE,2020,22(6):597-602.[doi:10.3969/j.issn.1672-271X.2020.06.009]
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分时段递减输注羟考酮在肝癌切除患者术后镇痛的应用()
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《医学研究与战创伤救治》（原医学研究生学报）[ISSN:1672-271X/CN:32-1713/R]

卷:
第22卷
期数:
2020年6期
页码:
597-602
栏目:
临床研究
出版日期:
2020-11-20

文章信息/Info

Title:
Application of the time-scheduled decremental infusion of oxycodone for postoperative patient-controlled analgesia after liver cancer resection
作者:
王青; 周斌; 张韬; 顾小萍
作者单位：210009南京，南京医科大学附属鼓楼临床医学院麻醉科（王青、顾小萍）;210002南京，东部战区总医院秦淮医疗区麻醉科（周斌、张韬）
Author(s):
WANG Qing1; ZHOU Bin2; ZHANG Tao2; GU Xiao-ping1
（1.Department of Anesthesiology，Drum Tower Medical College of Nanjing Medical University，Nanjing 210009，Jiangsu，China；2.Department of Anesthesiology, Qinhuai Medical Treatment Area of General Hospital of Eastern Theater Command，PLA，Nanjing 210002，Jiangsu，China）
关键词:
分时段; 递减; 术后镇痛; 肝癌; 羟考酮
Keywords:
time-scheduled;  decreasing;  postoperative analgesia;  liver cancer;  oxycodone
分类号:
R735.7；R614
DOI:
10.3969/j.issn.1672-271X.2020.06.009
文献标志码:
A
摘要:
目的探讨分时段递减输注羟考酮用于开腹肝癌切除患者术后镇痛的临床效果、不良反应及适宜递减速率。 方法选择2017年5月至2019年9月在东部战区总医院秦淮医疗区接受开腹肝癌切除术的患者120例，根据随机单盲抽签法分为4组：对照组、20%递减组（D20%组）、40%递减组（D40%组）、80%递减组（D80%组），每组各30例。手术结束时接受静脉自控镇痛(PCIA)，PCIA泵配置均为10 μg/(kg·mL)羟考酮配至150 mL。4组镇痛背景输注参数：对照组输注速率持续为1 mL/h（国内传统PCIA常用输注速率）；D20%组：初始输注速率3 mL/h，术后8 h、24 h分别递减输注速率20%；D40%组：初始输注速率3 mL/h，术后8 h、24 h分别递减输注速率40%；D80%组：初始输注速率3 mL/h，术后8 h递减输注速率80%，24 h后无背景输注。其他PCIA泵设置参数4组均一致。记录患者术后4 h、8 h、16 h、24 h和48 h视觉模拟疼痛评分(VAS)，术后0～8 h、8～24 h、24～48 h时间段内最高VAS评分及镇痛补救率；48 h内镇痛泵按压次数及药物累计用量；术后48 h内不良反应发生率及镇痛满意度评分。结果与对照组比较，术后4 h、8 h，D20%组、D40%组、D80%组动态及静态VAS评分均显著降低（P<0.05）；术后16 h，D20%组、D40%组动态及静态VAS评分均显著降低（P<0.05）；术后16 h及24 h，D80%组动态及静态VAS评分均大于其他3组（P<0.05）。术后0～8 h，D20%组、D40%组、D80%组最大VAS评分、镇痛补救率相较于对照组均显著降低（P<0.05）。术后8～24 h，D80%组最大VAS评分相较于其他3组均显著升高（P<0.05）。D20%组术后48 h镇痛泵药物累计用量明显高于其他3组（P<0.05）。D40%组术后48 h镇痛泵满意度评分[(4.4±0.0)分]明显高于D80%组[(3.4±1.1)分]及对照组[(3.5±0.9)分]，差异有统计学意义（P<0.05）。4组患者术后恶心、呕吐和其他不良反应发生率比较差异无统计学意义（P>0.05）。结论以0.03 mg/(kg·h)速率起始输注羟考酮并于术后8 h、24 h分别递减40%的PCIA镇痛方案可有效用于肝癌术后镇痛，患者满意度高，且不增加术后镇痛药物用量及不良反应发生率。
Abstract:
ObjectiveTo investigate the analgesic effect，adverse reaction and appropriate decreasing rate of the time-scheduled decremental infusion of oxycodone for postoperative patient-controlled analgesia in patients with open hepatocellular carcinoma.MethodsFrom May 2017 to September 2019，120 patients who underwent liver cancer resection were randomly divided into four groups according to a single blind lottery: control group，20% decremental group （group D20%），40% decremental group （group D40%），80% decremental group （group D80%）, with 30 cases in each group. Patient-controlled intravenous analgesia (PCIA) were received at the end of surgery. PCIA pumps were configured with 10 μg/(kg·mL) oxycodone to 150 mL. The infusion parameters of the four groups of analgesia background were 1 mL/h infusion rate in the control group, 3 mL/h initial infusion rate in group D20%, with 20% reduced infusion rate at 8 h and 24 h after the operation，3 mL/h initial infusion rate in group D40% with 40% reduced infusion rate at 8 h and 24 h after the operation，3 mL/h initial infusion rate in group D80% with 80% reduced infusion rate at 8 h after the operation, and no background infusion performed 24 h later. The other setting parameters of PCIA pumps were the same in 4 groups. Visual analogue scale (VAS) was obtained at 4, 8, 16, 24 and 48 h after surgery. The highest VAS score and analgesic recovery rate were obtained within 0-8 h, 8-24 h and 24-48 h after operation. The times of analgesic pump compression and cumulative drug consumption within 48 h and the incidence of adverse reactions and score of analgesia satisfaction within 48 h after surgery were recorded.ResultsCompared with the control group，dynamic and static VAS scores of group D20%，group D40% and group D80% were significantly reduced at 4 and 8 h after surgery (P<0.05). At 16 h after surgery，dynamic and static VAS scores of group D20% and group D40% were significantly reduced (P<0.05). The dynamic and static VAS scores of group D80% were higher than those of the other three groups at 16 h and 24 h after surgery. Compared with the control group, the highest VAS score and analgesic recovery rate of group D20%，group D40%and group D80% were significantly reduced at 0-8 h after surgery (P<0.05). The highest VAS score of group D80% were significantly higher than the other three groups at 8-24 h after surgery (P<0.05). The total consumption of analgesic pump drugs in group D20% was significantly higher than the other three groups at 48 hours (P<0.05). The score of analgesia satisfaction within 48 h after surgery in group D40% (4.4±0.0) was significantly higher than that in group D80% (3.4±1.1) and control group (3.5±0.9) (P<0.05). There was no significant difference in the incidence of postoperative nausea，vomiting and other adverse reactions among the four groups (P>0.05).ConclusionThe PCIA analgesic regimen with the rate of 0.03 mg/(kg·h) and a decrease of 40% at 8 h and 24 h postoperatively can be effectively for postoperative analgesia of liver cancer resection, which brings high satisfaction of patients, no increase in the dosage of postoperative analgesic drugs and the incidence of adverse reactions

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更新日期/Last Update: 2020-12-01