羟考酮联合肋间神经阻滞在老年患者胸科术后镇痛中的临床观察

目的:观察羟考酮及其联合肋间神经阻滞在老年胸科术后镇痛的效果.方法:择期行开胸肺癌根治术患者120例,年龄65～75岁,性别不限,BMI 18～25 kg/m2,美国麻醉师协会(American Society of Anesthesiologists,ASA)Ⅰ～Ⅱ级.无慢性疼痛,无酒精滥用.采用随机数字表法将病人分为4组:羟考酮组(A组)、羟考酮组联合肋间神经阻滞组(B组)、舒芬太尼组(C组)和舒芬太尼联合肋间神经阻滞组(D组).4组均接受全凭静脉麻醉,术后进行统一管理.A组和B组患者静脉自控镇痛(patientcontrolled intravenous analgesia,PCIA)配方:羟考酮50 mg稀释至100 mL,无背景剂量,Bolus 4 mL,锁定时间5 min;C组和D组舒芬太尼150 μg,背景剂量2 mL,Bolus 0.5 mL,锁定时间15 min;且B组和D组关胸前行肋间神将阻滞.观察术后4,12,24,48 h静息及咳嗽视觉模拟评分(visual analogue scale,VAS)、镇痛药物使用量、镇痛满意度及恶心呕吐等并发症.结果:A组静息、咳嗽VAS评分低于C组(P＜0.008),毒副作用差异无统计学意义.B组较A组镇痛药物使用更少,较A组和D组恶心呕吐发生率低(P＜0.008).结论:羟考酮静脉自控镇痛静息、咳嗽VAS评分低于舒芬太尼且羟考酮静脉自控镇痛联合肋间神经阻滞阿片镇痛药物使用量少,恶心呕吐发生率低.

Observation of oxycodone with intercostal nerve blockade for postoperative analgesia in elderly thoracotomy

Objective:To assess the efficacy of oxycodone with intercostal nerve blockade for postoperative analgesia in elderly after thoracotomy.Methods:One hundred and twenty patients,aged 65-75 years,both sexes,with BMI of 18-25 kg/m2,American Society of Anesthesiologists (ASA) Ⅰ-Ⅱ,scheduled for elective thoracotomy,were randomly divided into four groups using a random number:Group A (oxycodone),Group B (oxycodone with intercostal blockade),Group C (sufentanil),Group D (sufentanil with intercostal blockade).Patient controlled intravenous analgesia (PCIA) solution contained oxycodone 50 mg in 100 mL NS,without background infusion,Bolus 4 mL,lockout interval 5 min in group A and B.PCIA solution contained sufentanil 150 μg in 100 mL NS,basal infusion 2 mL/h,Bolus 0.5 mL,lockout interval 5 min in group C and D.Before closure of the chest,group B and D use intercostal nerve blockade.The visual analogue scale (VAS) of both rest and cough,analgesics dosage,level of patient's satisfaction with analgesia,and analgesia-related adverse events were recorded.Results:Group A showed comparable for pain relief both at rest and cough,adverse effects have no significantly differences than Group C;Group B use less analgesics than Group A,adverse events have no significantly differences,and lower incidence of nausea and vomiting than Group C and D.Conclusion:Oxycodone showed comparable for pain relief both at rest and cough than sufentanil in PCIA;oxycodone with intercostal nerve blockade reduced analgesics dosage and incidence of nausea and vomiting in elderly thoracotomy.