王美青　赵维珊　殷　飞　雷　钧　孙　杨南京市胸科医院麻醉科，江苏南京210029

羟考酮与地佐辛用于胸腔镜术后苏醒期镇痛的比较

王美青赵维珊殷飞雷钧孙杨▲
南京市胸科医院麻醉科，江苏南京210029

目的探讨单剂量羟考酮与地佐辛用于胸腔镜手术术后苏醒期镇痛的安全性和有效性。方法选择2015年5月～2016年5月于南京市胸科医院择期行胸腔镜手术的患者60例，采用随机数字表法将其分为羟考酮组（O组）和地佐辛组（D组），每组各30例。两组分别于手术结束前20 min静脉推注0.1 mg/kg羟考酮或0.1 mg/kg地佐辛。观察两组患者术后苏醒时间、拔管时间，以及拔管后5 min（T1）、2 h（T2）、4 h（T3）的VAS评分及Ramsay镇静评分；观察用药前5 min、用药即刻、用药后5 min平均动脉压（MAP）、心率（HR）、术后躁动、嗜睡、呼吸抑制及恶心呕吐的发生率。结果两组术后苏醒时间和拔管时间比较，差异无统计学意义（P＞0.05），但O组T1、T2、T3VAS评分较D组降低（P＜0.01）；O组T1时点的Ramsay镇静评分高于D组（P＜0.05）；O组术后躁动发生率明显低于D组（P＜0.01），两组嗜睡、呼吸抑制和恶心呕吐的发生率比较，差异无统计学意义（P＞0.05）。两组用药前5 min、用药即刻及用药后5 min MAP和HR比较差异均无统计学意义（P＞0.05）。结论羟考酮用于胸腔镜术后苏醒期镇痛安全有效，与地佐辛比较，其对内脏痛的治疗效果更佳且清醒镇痛，明显降低术后躁动的发生率，不增加术后恶心呕吐等不良反应的发生率，并且不延长术后苏醒和拔管时间。

胸腔镜手术；羟考酮；地佐辛；术后镇痛；苏醒期

［Abstract］Objective To investigate the efficacy and safety in the thoracoscopic surgery for postoperative analgesia during the recovery time with a single dose of Oxycodone and Dezocine.Methods Sixty patients undergoing selective thoracoscopic surgery in Nanjing Chest Hospital from May 2015 to May 2016 were selected.These patients were randomly divided into Oxycodone group（group O）and Dezocine group（group D）by random number table，30 patients in each group.0.1 mg/kg Oxycodone or Dezocine were administered respectively in two groups.Awakening time after anesthesia，extubation time，the VAS score and Ramsay sedation score at 5 min，2 h，and 4 h after extubation were observed in two groups，meanwhile，the MAP and HR at 5 min before medication，medication immediately and 5 min after medication，as well as，the incidence of postoperative sleepiness，agitation，respiratory depression and postoperative nausea and vomiting（PONV）were recorded.Results Compared withgroup D，postoperative awakening time and extubation time of the group O were not significant difference（P＞0.05），but the VAS score at 5 min，2 h and 4 h after extubation were lower in group O（P＜0.01）；the Ramsay sedation score at 5 min of the group O was higher than that of the group D（P＜0.05），and the incidence of postoperative agitation was lower than that of the group D（P＜0.01）．There were no significant difference in the incidence of postoperative sleepiness，respiratory depression and PONV between two groups（P＞0.05）.The change of MAP and HR of medication immediately and 5 min before and after medication between two groups was not significant difference（P＞0.05）.Conclusion In contrast with Dezocine，Oxycodone for thoracoscopic postoperative analgesia in the recovery time is safe and effective，has better effect on visceral pain and awake analgesia，not only significantly reduce the incidence of postoperative agitation，does not increase the incidence of postoperative nausea and vomiting and other adverse reactions，but also does not prolong the postoperative awakening and extubation time.

［Key words］Thoracoscopic surgery；Oxycodone；Dezocine；Postoperative analgesia；Recovery time

胸腔镜手术虽属于微创，但其术后疼痛仍属于中重度疼痛，尤其是炎性液体和胸腔引流管刺激膈肌、胸膜和肺都会引起术后疼痛，以及双腔支气管导管和导尿管的刺激都会增加术后疼痛和不适［1］。……