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在胸腔镜肺部手术多模式止痛中使用氧化:单中心回顾性观察性研究

Ran Zhang¹, Yue Fu², Weixin Zhang¹

¹Department of Anesthesiology, Peking University People's Hospital, Beijing, China.

|February 3, 2026

概括

在胸腔镜肺部手术后,氧化患者控制的静脉静脉止痛 (PCIA) 提供了更好的疼痛管理和比sufentanil PCIA更少的副作用. 这种阿片类药物转换导致改善睡眠和更短的住院时间.

科学领域:

麻醉学麻醉学
药理学药理学是指药理学的学科.
胸部外科手术胸部外科手术

背景情况:

在视频辅助胸腔镜手术 (VATS) 中,sufentanil患者控制的静脉注射止痛 (PCIA) 涉及持续输注,增加阿片类药物负载和副作用.
苏芬坦尼尔缺乏卡帕受体覆盖,这对于在VATS期间的内脏疼痛管理很重要.
氧化,由于其双重mu/kappa阿片类受体配置和更长的作用时间,是仅需PCIA的潜在替代品.

研究的目的:

在接受VATS的患者中,比较基于氧的PCIA与基于sufentanil的PCIA的疗效和安全性.
为了评估疼痛评分,阿片类药物消耗和在标准化胸部副脊椎阻断 (TPVB) 和非类固醇抗炎药物 (NSAID) 多式止痛方案中的不良事件.

主要方法:

2017年1月至2018年12月进行了一项单中心回顾性研究.
成年患者接受VATS与多模式止痛治疗,被分配给sufentanil (S) 或 oxycodone (O) PCIA.
用一对一的倾向分数匹配 (每组n=527) 来比较结果,包括阿片类药物消费,疼痛分数,止痛药需求,术后恶心和吐 (PONV),头,睡眠质量和停留时间.

主要成果:

与sufentanil PCIA (0.8-1.2 mg对27.4-36.5 mg;P<.001) 相比,氧化PCIA导致在术后第一和第二天的阿片类药物消耗 (吗啡等价物) 显著降低.
氧化组的患者报告了更好的睡眠质量 (73.1%与61.9%相比;P<.001),并经历了较少的PONV (1.5%与6.5%相比;P<.001) 和头 (3.8%与9.9%相比;P<.001).
虽然在第二天的休息疼痛得分偏好了氧化 (P=.043),但运动疼痛得分相似. 患者使用氧化的频率更高 (P<.01),而手术后住院时间在氧化组较短 (P=.002).

结论:

基于氧化的PCIA在VATS的TPVB-NSAID多式疗法中提供了与基于sufentanil的PCIA相比较的止痛作用.
与sufentanil PCIA相比,oxycodone PCIA与减少阿片类药物消费,减少不良反应 (PONV,头),改善睡眠和更短的住院时间有关.
在接受胸腔镜肺部手术的患者中,氧化代表了PCIA的有利替代品,增强了康复和患者舒适度.

关键词:

多模式止痛药多模式止痛药氧化的氧化是什么?术后止痛药术后止痛药胸腔镜外科手术胸腔镜外科手术

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