【摘要】 目的 探讨奥赛利定静脉自控镇痛对后路腰椎开放性手术患者术后恢复质量的影响。方法 选择2025年1—8月择期行后路腰椎开放性手术的患者，年龄18～79岁，BMI 20.0～30.0 kg/m~2,ASAⅠ—Ⅲ级。采用随机数字表法将患者分为两组：奥赛利定组和舒芬太尼组。手术结束前30 min,奥赛利定组静脉注射奥赛利定0.03 mg/kg,舒芬太尼组静脉注射舒芬太尼0.2μg/kg。手术结束即刻连接静脉镇痛泵，奥赛利定组使用奥赛利定0.3 mg/kg,舒芬太尼组使用舒芬太尼2μg/kg,两组均复合氟比洛芬酯150 mg和托烷司琼4 mg,加入生理盐水稀释至100 ml。术后48 h内若患者有效按压镇痛泵后VAS疼痛评分仍≥4分，静脉滴注氟比洛芬酯50 mg补救镇痛。主要指标为术后24 h 15项恢复质量(QoR-15)评分。次要指标包括拔管后10 min、术后6、12、24、48 h的静息时、活动时(咳嗽)VAS疼痛评分以及镇静舒适度量表(BCS)评分，术后48 h QoR-15评分，术后首次肛门排气时间，术后48 h内镇痛泵有效按压次数和补救镇痛率，术前2 h、术后24 h和48 h外周血白细胞介素-6(IL-6)、肿瘤坏死因子-α(TNF-α)浓度。不良反应包括术后48 h内恶心呕吐、头晕及腹胀等。结果 共纳入患者60例，每组30例。与舒芬太尼组比较，奥赛利定组术后24 h QoR-15总分、疼痛及身体舒适度评分明显升高，术后6、12、24 h静息和活动时VAS疼痛评分、术后24 h血清IL-6、TNF-α浓度、术后48 h恶心呕吐发生率均明显降低，术后48 h内镇痛泵有效按压次数与补救镇痛率明显降低，术后6、12、24 h BCS评分明显升高，术后首次肛门排气时间明显缩短(P<0.05)。两组术后48 h的QoR-15评分、静息和活动时VAS疼痛评分、血清IL-6、TNF-α浓度差异均无统计学意义。结论奥赛利定静脉自控镇痛可安全地用于后路腰椎开放性手术患者术后静脉自控镇痛。与舒芬太尼比较，奥赛利定可显著提高患者术后镇痛效果，减少恶心呕吐等不良反应，提高患者术后恢复质量。更多还原

【Abstract】 Objective To investigate the effect of patient-controlled intravenous analgesia(PCIA) with oliceridine on the postoperative quality of recovery in patients undergoing posterior open lumbar surgery. Methods Patients aged 18-79 years with BMI 20.0-30.0 kg/m~2 and ASA physical status Ⅰ-Ⅲ, who underwent elective posterior open lumbar spine surgery from January to August 2025, were enrolled. They were randomly assigned to two groups using the random number table method: the oliceridine group and the sufentanil group. Thirty minutes before the end of surgery, the oliceridine group received intravenous oliceridine 0.03 mg/kg, while the sufentanil group received intravenous sufentanil 0.2 μg/kg. Immediately after surgery, a intravenous analgesia pump was connected, the oliceridine group received oliceridine 0.3 mg/kg and the sufentanil group received sufentanil 2 μg/kg, both groups combined with flurbiprofen axetil 150 mg and tropisetron 4 mg, diluted with normal saline to a total volume of 100 ml. If the patient’s VAS pain score was ≥ 4 after pressing the analgesia pump within 48 hours postoperatively, an additional 50 mg of flurbiprofen axetil was administered intravenously for rescue analgesia. The primary outcome was the 15-item quality of recovery(QoR-15) score at 24 hours postoperatively. The secondary outcomes included resting and activity(coughing) VAS pain score and Bruggrmann comfort scale(BCS) score at 10 minutes after extubation, 6, 12, 24, and 48 hours postoperatively, QoR-15 score at 48 hours postoperatively, the time to first flatus postoperatively, the number of effective presses of the patient-controlled analgesia pump and rescue analgesia within 48 hours postoperatively, the concentrations of interleukin-6(IL-6) and tumor necrosis factor-α(TNF-α) in peripheral blood at 2 hours preoperatively, 24, and 48 hours postoperatively. Adverse reactions included nausea and vomiting, dizziness, abdominal distension within 48 hours postoperatively. Results Sixty patients were enrolled in this study, 30 patients in each group. Compared with the sufentanil group, the oliceridine group had a significantly higher total QoR-15 scores, the subscales of pain and physical comfort at 24 hours postoperatively, significantly lower VAS pain scores(resting and during activity) at 6, 12, and 24 hours postoperatively, serum concentrations of IL-6 and TNF-α at 24 hours postoperatively, and incidence of nausea and vomiting at 48 hours postoperatively(P < 0.05). Meanwhile, compared with the sufentail group, the effective pressing times of the PCIA pump and rescue analgesia rate within 48 hours postoperatively were significantly reduced, the BCS scores were significantly increased at 6, 12, and 24 hours postoperatively, and the time to first flatus postoperatively was significantly shortened in the oliceridine group(P < 0.05). There were no significant differences between the two groups in QoR-15 score, resting or during activity VAS pain scores, or serum IL-6 and TNF-α levels at 48 hours postoperatively. ConclusionOliceridine-based PCIA is safe for postoperative analgesia in patients undergoing open posterior lumbar surgery. Compared with sufentanil, oliceridine provides superior analgesic efficacy, reduces adverse reactions such as nausea and vomiting, and improves the postoperative quality of recovery.更多还原