不同剂量羟考酮对无痛人流术后宫缩痛和情绪量值的影响

Effect of different doses of oxycodone hydrochloride on uterine cramping pain and emotion in painless artificial abortion

中文关键词: 羟考酮  无痛人流  宫缩痛  情绪

英文关键词: Oxycodone  Painless artificial abortion  Uterus cramping pain  Emotion

中文摘要:

      
目的 观察三种不同剂量羟考酮对患者人工流产术后宫缩痛和情绪量值的影响。
方法 选择行无痛人工流产术患者400例, 年龄17～38岁, BMI 18.5～23.9 kg/m², ASA Ⅰ或Ⅱ级。采用随机数字表法分为四组: 羟考酮0.06 mg/kg组(O1组)、羟考酮0.08 mg/kg组(O2组)、羟考酮0.1 mg/kg组(O3组)、芬太尼组(F组), 每组100例。O1、O2、O3组分别静脉注射羟考酮0.06、0.08、0.1 mg/kg, F组静脉注射芬太尼1 μg/kg。四组丙泊酚诱导剂量2.5 mg/kg, 患者术中出现体动反应时追加丙泊酚0.4 mg/kg。记录患者丙泊酚用量、手术时间、苏醒时间; 记录患者麻醉诱导前(T0)、睫毛反射消失时(T1)、术中宫腔操作时(T2)、术毕苏醒时 (T3)的HR、MAP和RR; 采用数字评分法(NRS)评价患者苏醒后即刻、10、30、60 min的宫缩痛程度; 记录患者术后满意度评分; 采用正性负性情绪量表(PANAS)分别于术前和术后1 h评定患者情绪; 记录患者补救镇痛；记录恶心、呕吐、头晕、呼吸抑制、皮肤瘙痒、尿潴留、出汗等不良反应情况。
结果 O2组、O3组和F组丙泊酚用量明显少于O1组(P<0.05), 苏醒时间明显短于O1组(P<0.05)。O1组、O2组和O3组不同时点宫缩痛NRS评分明显低于F组(P<0.05), 术后满意度评分明显高于F组(P<0.05)。四组术后1 h正性情绪量值明显高于术前(P<0.05), 负性情绪量值明显低于术前(P<0.05), O1组、O2组和O3组术后1 h正性情绪量值明显高于F组(P<0.05), 补救镇痛例数明显少于F组(P<0.05)。四组术后头晕、恶心、呕吐等不良反应差异无统计学意义，四组均未发生呼吸抑制、皮肤瘙痒、苏醒期躁动、尿潴留、出汗等不良反应。
结论 0.08 mg/kg羟考酮配伍丙泊酚用于无痛人工流产术, 麻醉效果确切, 镇痛完善, 患者满意度高, 并且能提高正性情绪量值。

英文摘要:

      
Ojective To evaluate the effect of three different doses of oxycodone hydrochloride injection on uterine cramping pain and emotion in patients of artificial abortion.
Methods Four hundred female patients, aged 17 - 38 years, BMI 18.5 - 23.9 kg/m², falling into ASA physical status Ⅰ or Ⅱ, undergoing elective artificial abortion were randomized into four groups using a random number table: group O1 (oxycodone 0.06 mg/kg), group O2 (oxycodone 0.08 mg/kg), group O3 (oxycodone 0.1 mg/kg), and group F, 100 cases in each. In group O1, group O2 and group O3, oxycodone 0.06, 0.08, 0.1 mg/kg were intravenously injected respectively, while in group F fentanyl 1 μg/kg was intravenously injected. Then, propofol 2.5 mg/kg was intravenously injected as induced dose. The operation was started when eyelash reflexes disappeared, propofol 0.4 mg/kg was intravenously injected when body movement appeared during the operation. The propofol doses, operation time and recovery time were recorded. HR, MAP, RR before anesthesia (T0), when loss of eyelash reflex (T1), operation (T2) and recovery (T3) were recorded. The uterine cramping pain was assessed with numerical rating scale (NRS) at recovery, 10, 30, 60 min after operation. Patients' satisfaction was recorded after operation. Patients' emotion was assessed with positive and negative affect scale(PANAS) both before and after operation in one hour. Rescue analgesia, nausea and vomiting, dizziness, respiratory depression, pruritus, uroschesis, cognitive dysfunction, sweatiness were recorded.
Results The propofol doses and recovery time in groups O2, O3 and F were significantly lower than those in group O1 (P < 0.05). The NRS score of uterine cramping pain in groups O1, O2 and O3 were significantly lower than that in group F (P < 0.05). Patients' satisfaction in groups O1, O2 and O3 were significantly higher than that in group F(P < 0.05). The positive affective score after operation in one hour among the four groups were significantly higher than that before operation (P < 0.05), and the negative affective score after operation in one hour among the four groups were significantly lower than that before operation (P < 0.05). The positive affective score after operation in one hour in groups O1, O2 and O3 were significantly higher than that in group F (P < 0.05), and the rescue analgesia in groups O1, O2 and O3 were significantly lower than that in group F (P < 0.05). There were no significant differences among the four groups as to the dizziness, nausea and vomiting. No respiratory depression, pruritus, emergence agitation, cognitive dysfunction, uroschesis and sweatiness were reported.
Conclusion Oxycodone 0.08 mg/kg combined with propofol in patients undergoing artificial abortion is effective in preventing uterine cramping pain. Furthermore, the patients' satisfaction and positive affective score can also be improved.