羟考酮用于术后静脉自控镇痛的心血管安全性与镇痛疗效

LIU Wen-guang; SHAN Wen-ting; LIU Hua-dong; LI Jun-feng

doi:10.3969/j.issn.1009-8933.2025.03.002

摘要：Background Postoperative pain,if not effectively controlled,can trigger sympathetic activation and stress re-sponses that increase the risk of cardiovascular complications.Oxycodone,a semisynthetic opioid acting on both μ-and κ-receptors,may provide stable analgesia with less hemodynamic fluctuation compared with the pure μ-agonist sufentanil.This study aimed to compare the efficacy and cardiovascular safety of oxycodone-based versus sufent anil-based intravenous patient-controlled analgesia(IV-PCA)after laparoscopic abdominal surgery.Methods This single-center retrospective comparative study included patients who underwent laparoscopic abdominal sur-gery between March 2024 and March 2025.According to their postoperative PCA regimen,patients were divided into an oxycodone group and a sufentanil group.The primary endpoint was the incidence of cardiovascular adverse events(CVAE)within 48 h after surgery,including hypotension,bradycardia,and arrhythmia.Logistic regression was used to identify independent predictors of CVAE,and receiver operating characteristic(ROC)analysis as-sessed discriminative performance.Results A total of 356 patients were analyzed(oxycodone n=197;sufentanil n=159).The incidence of CVAE was significantly lower in the oxycodone group than in the sufentanil group(5.2%vs.12.1%,P=0.021).Oxycodone provided comparable analgesic intensity with fewer PCA bolus attempts(36±15 vs.52±17,P<0.001)and higher patient satisfaction scores(4.3±0.5 vs.4.1±0.5,P=0.002).Multivariate logistic re-gression identified sufentanil use(OR:2.53,95%CI:1.16-5.84,P=0.018)as independent predictors of CVAE.Conclusions Oxycodone-based IV-PCA provided effective postoperative analgesia with a lower incidence of car-diovascular adverse events compared with sufentanil-based PCA.The results suggested that oxycodone offered a fa-vorable balance between analgesic efficacy and hemodynamic stability,making it a safer alternative for postopera-tive pain management in patients at cardiovascular risk.[S Chin J Cardiol 2025;26(3):145-154]