谢雨逸孜　王江玲　蔡昀方

[摘要] 目的 觀察盐酸羟考酮与舒芬太尼在腹腔镜宫颈癌根治术中防治瑞芬太尼术后爆发痛的比较研究。 方法 将60例患者随机分为三组羟考酮组（Q组）和舒芬太尼组（S组）及生理盐水对照组（C组），每组20例。冲洗止血时停用七氟烷和顺式阿曲库铵，缝皮时停用丙泊酚和瑞芬太尼，同时对Q组患者静脉注射羟考酮注射液0.1 mg/kg，对S组患者静脉注射舒芬太尼0.1 μg/kg，对C组患者静脉注射等量0.9%生理盐水。观察三组患者缝皮结束（T0）、拔管时（T1）、拔管后5 min（T2）、15 min（T3）、30 min（T4）的MAP、HR以及T1至T4时间的视觉模拟评（VAS）评分，记录患者恶心呕吐、嗜睡、烦躁、呼吸抑制等并发症及追加的镇痛药量。 结果 Q组与S组的MAP值，HR值及VAS评分在T1至T4四个时间点均低于C组，Q组MAP值及HR值在T2及T3时间低于S组，Q组恶心呕吐发生率高于S组，差异有统计学意义（P<0.05）；Q组及S组在镇痛追加及烦躁明显低于C组，差异有统计学意义（P<0.01）。 结论 手术结束时静脉注射0.1 mg/kg 羟考酮能够有效防治瑞芬太尼麻醉后的术后爆发痛和痛觉过敏，羟考酮镇痛效果良好且不影响苏醒质量，无呼吸抑制发生，是用于腔镜宫颈癌根治术后安全有效的镇痛方法，但要注意不良反应恶心呕吐的发生，临床应用需提前预防。

[关键词] 盐酸羟考酮；瑞芬太尼；全身麻醉；爆发痛

[中图分类号] R614 [文献标识码] B [文章编号] 1673-9701（2018）20-0131-04

Clinical effect of oxycodone hydrochloride in the prevention and treatment of breakthrough pian after general anesthesia using remifentanil

XIE Yuyizi WANG Jiangling CAI Yunfang ZHANG Runze ZHU Yejing

Department of Anesthesiology，Zhejiang Cancer Hospital，Hangzhou 310022，China

[Abstract] Objective To compare the effect of oxycodone hydrochloride and sufentanil in the prevention and treatment of postoperative breakthrough pain after using remifentanil in laparoscopic radical hysterectomy. Methods 60 patients were randomly divided into three groups： Oxycodone group（Q group）， sufentanil group（S group） and saline control group（C group）， with 20 cases in each group. Sevoflurane and cisatracurium were discontinued during hemostasis by washing. Propofol and remifentanil were discontinued when suturing the skin， and meanwhile， patients in group Q， group S and group C were given oxycodone of 0.1 mg/kg， sufentanil of 0.1 μg/kg， and the same amount of 0.9% normal saline through intravenous injection， respectively. At the end of the skin suture（T0）， at the time of extubation（T1）， 5 min（T2）， 15 min（T3） and 30 min（T4） after extubation， we observed MAP， HR and the visual analogue scale（VAS） from T1 to T4 of the three groups， and recorded nausea and vomiting， somnolence， dysphoria， respiratory depression and other complications and additional dose of analgesics. Results The MAP， HR and VAS scores from T1 to T4 of group Q and group S were significantly lower than those of group C； the MAP and HR values at T2 and T3 of group Q were significantly lower than those of group S， and the incidence of nausea and vomiting of group Q were significantly higher than group S（P<0.05）. The additional dose of analgesics and dysphoria of group Q and S were significantly lower than that of group C（P<0.01）. Conclusion Intravenous injection of oxycodone with 0.1 mg/kg at the end of surgery can effectively prevent the postoperative breakthrough pain and hyperalgesia after remifentanil anesthesia. Oxycodone has good analgesic effect without affecting the quality of reviving and with no respiratory depression. It is a safe and effective method for analgesia after laparoscopic radical hysterectomy. However， it is necessary to pay attention to the occurrence of adverse reactions such as nausea and vomiting and should be prevented in advance.

[Key words] Oxycodone hydrochloride； Remifentanil； General anesthesia； Breakthrough pain

随着腔镜技术的发展，目前在妇科恶性肿瘤患者中，腹腔镜下宫颈癌根治术及子宫内膜癌根治术等亦发展迅猛。由于CO2气腹的特殊性，对麻醉要求较高，一般都选择全身麻醉[1]。瑞芬太尼是新型的阿片类受体激动剂，该药物具有起效快，半衰期短，停用药物后体内无蓄积，但是在临床应用中，停用瑞芬太尼后，大多患者疼痛发生早且程度强[2]。盐酸羟考酮是μ，к双受体的激动剂，由于羟考酮激动к受体，有研究认为盐酸羟考酮对内脏痛的止痛效果较单纯μ受体激动剂更好[3-5]。为此本研究拟观察羟考酮在预防瑞芬太尼引起术后爆发痛的效果，为临床用药提供新的参考，现报道如下。……