羟考酮复合右美托咪定对≥ 75 岁老年结肠癌 患者术后自控静脉镇痛的效果分析

Effect of oxycodone combined with dexmedetomidine on postoperative patient-controlled intravenous analgesia in elderly patients over 75 years of age with colon cancer

摘要:

目的 评价羟考酮复合右美托咪定用于≥ 75 岁老年结肠癌患者术后自控静脉镇痛（PCIA）的效果。 方法 选取2017 年10 月—2018 年10 月在天津市第三中心医院分院择期全身麻醉腹腔镜结肠癌手术的90 例 老年患者作为研究对象。采用随机数字表法分为A、B 及C 组，每组30 例。手术结束前15 min 时分别静脉 注射托烷司琼4 mg 和羟考酮0.1 mg/kg，同时连接PCIA 泵。A、B 及C 组药物配制分别用羟考酮0.6、0.4 及 0.2 mg/kg+ 右美托咪定2μg/kg+ 托烷司琼4 mg。用生理盐水配成100 ml，患者自控单次给药剂量0.5 ml，锁 定时间15 min，背景输注速率2 ml/h，维持视觉模拟评分≤ 4 分。记录术后<48 h PCIA 泵有效按压次数和镇 痛补救情况，计算镇痛补救率；记录术后恶心、呕吐、头晕、嗜睡、呼吸抑制、皮肤瘙痒、心动过缓、低血 压及过度镇静的发生情况；记录术后72 h 镇痛满意度。结果 3 组患者术后未出现呕吐、呼吸抑制、皮肤瘙痒、 过度镇静、心动过缓及低血压等不良反应。3 组患者头晕发生率比较，差异无统计学意义（P >0.05）。A 组患 者恶心、嗜睡发生率高于B、C 组（P <0.05）；C 组PCIA 泵有效按压次数和镇痛补救率高于A、B 组（P <0.05）； C 组镇痛满意度低于A、B 组（P <0.05）。结论 羟考酮0.4 mg/kg 复合右美托咪定2μg/kg 更适合≥ 75 岁 老年结肠癌患者术后自控静脉镇痛。

关键词:结肠肿瘤;老年人;麻醉品;镇痛，病人控制

Abstract:

Objective To evaluate the effect of oxycodone combined with dexmedetomidine on postoperative patient-controlled intravenous analgesia (PCIA) in elderly patients over 75 years of age with colon cancer. Methods Totally 90 elderly patients underwent total anesthesia for elective laparoscopic colon cancer surgery were divided into 3groups (n = 30 each) by using a random number table. 15 min before the end of the operation, tropisetron 4 mg and oxycodone 0.1 mg/kg were injected intravenously, and the PCIA pump was connected simultaneously. Drug preparation: In A, B and C groups, the PCIA solution contained oxycodone 0.6, 0.4, and 0.2 mg/kg+ dexmedetomidine 2 μg/kg+ tropisetron 4 mg in 100 ml of 0.9% normal saline,respectively. The PCIA pump was set up to deliver a 0.5 ml bolus dose with a 15-min lockout interval and background infusion at 2 ml/h, and the Visual Analogue Scale (VAS) score was maintained at ≤ 4 points. The number of PCIA effective compressions and analgesic remediation within 48 hours after surgery were recorded, and the analgesic remediation rate was calculated. Postoperative nausea, vomiting, dizziness, lethargy, respiratory depression, itchy skin, bradycardia, hypotension, and excessive sedation were recorded. The analgesic satisfaction was recorded 72 h after surgery. Results No adverse reactions, such as vomiting, respiratory depression, pruritus, excessive sedation, bradycardia, or hypotension, occurred in the 3 groups after surgery. There was no significant difference in the incidence of dizziness among the three groups (P > 0.05). The incidence of nausea and sleepiness in group A was higher than that in group B and C (P < 0.05). PCIA pump effective compressions and analgesia recovery rate in group C were higher than those in group A and group B (P < 0.05). Analgesia satisfaction of group C was lower than that of group A and group B (P < 0.05). Conclusions Oxycodone 0.4mg/kg combined with dexmedetomidine 2μg/kg is more suitable for postoperative patient-controlled intravenous analgesia in elderly patients over 75 years of age with colon cancer.

Key words:colonic neoplasms; aged; narcotics; analgesia, patient-controlled