Mechanically ventilated patients in the intensive care unit (ICU) experience both nociception and pain-related distress, while simultaneously being at risk of ventilator-induced lung injury (VILI). Implementing individualized analgesic regimens is crucial to facilitate lung-protective ventilation strategies. Although preclinical studies suggest that oxycodone may attenuate VILI, clinical evidence supporting its use in critically ill patients remains limited, particularly in the ICU setting.

To evaluate the effects of intravenous oxycodone on respiratory mechanics and clinical outcomes in mechanically ventilated ICU patients, with a specific focus on those who have undergone abdominal surgery, thereby providing a novel theoretical basis and practical guidance for optimizing analgesic management and mitigating VILI risk.

A prospective randomized controlled trial was conducted. A total of 94 adult patients (aged≥18 years) requiring analgesic intervention, with a mechanical ventilation duration exceeding 24 hours and an Critical-care Pain Observation Tool (CPOT) score ≥3, were enrolled from the ICU of Zhoushan Hospital between August 2023 and March 2025. Participants were randomly assigned to either the sufentanil group or the oxycodone group, with 47 patients in each group. Both groups received standard treatment for underlying conditions and were managed with mechanical ventilation according to a conventional lung-protective ventilation strategy. The sufentanil group received a continuous intravenous infusion of sufentanil via micropump (loading dose: 0.5-1.0 μg/kg; maintenance dose: 0.02-0.15 μg·kg^-1·h^-1), while the oxycodone group received a continuous intravenous infusion of oxycodone injection (diluted to 1 mg/mL with 0.9% saline or 5% glucose solution; loading dose: 0.03 mg/kg; initial maintenance dose: 2 mg/h). Dosages were adjusted based on CPOT scores to maintain pain control with a target CPOT score below 3. Both groups received propofol for sedation as clinically indicated. Routine assessments included pain evaluation, respiratory mechanics monitoring, and arterial blood gas analysis. Outcome measures included demographic characteristics, airway peak pressure (Ppeak), airway plateau pressure (Pplat), driving pressure (ΔP), dynamic compliance (Cdyn), mechanical power MP), oxygenation index (P/F), and ventilation ratio (VR), recorded at baseline (0 h) and at 4 h, 12 h, and 24 h after initiation of analgesia. Additionally, cumulative analgesic consumption over 24 hours (converted to morphine equivalent), total propofol dose over 24 hours, duration of MV, and length of ICU stay (ICU-LOS) were documented. The study compared the effects of the two analgesic regimens on respiratory mechanics and clinical efficacy. A prespecified subgroup analysis was performed among 37 patients who underwent abdominal surgery (sufentanil subgroup: n=17; oxycodone subgroup: n=20).

There was no significant interaction effect between group and time on respiratory mechanics and oxygenation/ventilation parameters (P>0.05). The main effect of group on these parameters was not statistically significant (P>0.05), whereas the main effect of time was significant for Ppeak, MP, and VR (P<0.05). Subsequent intergroup comparisons were conducted for total morphine equivalent dose (24-hour analgesic requirement), total propofol dose (24-hour sedative requirement), duration of mechanical ventilation, and ICU length of stay (LOS), with no statistically significant differences observed (P>0.05). However, a subgroup analysis restricted to patients who underwent abdominal surgery demonstrated a statistically significant difference in propofol dosage between the oxycodone and sufentanil groups (P<0.05).

Both oxycodone injection and sufentanil injection can effectively improve respiratory mechanics parameters and oxygenation-ventilation indices in mechanically ventilated ICU patients, thereby facilitating the implementation of lung-protective ventilation strategies and reducing the risk of VILI. In post-abdominal surgery patients requiring mechanical ventilation, oxycodone injection demonstrates superior efficacy in pain relief, allows for reduced use of sedative agents, mitigates clinical risks associated with high-dose sedation, and exhibits a more favorable safety profile.

重症监护病房（ICU）机械通气患者存在痛感觉、痛情绪的同时也面临呼吸机相关性肺损伤（VILI）的风险，需制订个体化镇痛方案，以更好地实施肺保护性通气，羟考酮注射液在ICU应用经验不多，已有动物模型研究表明羟考酮可改善VILI，但其临床效应尚未得到充分验证。

探讨羟考酮注射液对ICU机械通气患者尤其是腹部术后机械通气患者呼吸力学的影响及疗效，为临床优化镇痛策略及降低VILI风险提供新的理论依据和实践指导。

采用前瞻性随机对照研究，选取2023年8月—2025年3月舟山医院ICU收治的94例年龄≥18岁、机械通气时间>24 h且重症监护疼痛观察量表（CPOT）评分≥3分需镇痛治疗的患者作为研究对象，随机分为舒芬太尼组、羟考酮组，每组均为47例。两组患者均针对原发疾病进行治疗，按照常规肺保护性通气策略来实施机械通气，舒芬太尼组使用舒芬太尼注射液静脉微泵输注镇痛（负荷剂量0.5~1.0 μg/kg，维持剂量0.02~0.15 μg·kg^-1·h^-1），羟考酮组则使用羟考酮注射液静脉微泵输注（本品加0.9%氯化钠溶液或5%葡萄糖注射液稀释至1 mg/mL，负荷剂量0.03 mg/kg，维持起始剂量2 mg/h），均根据镇痛评分随时调整剂量，保持CPOT评分<3分。镇痛治疗的同时两组患者均应用丙泊酚注射液镇静治疗。两组常规进行疼痛评估、呼吸力学监测、血气分析化验，记录患者一般资料、镇痛药物治疗0 h、4 h、12 h、24 h的气道峰压（Ppeak）、气道平台压（Pplat）、驱动压（ΔP）、肺动态顺应性（Cdyn）、机械功（MP）、氧合指数（P/F）、通气比（VR），统计24 h镇痛药物使用总剂量并进行吗啡效价换算、24 h镇静药物丙泊酚使用总剂量、机械通气时间和ICU住院时间（ICU-LOS）。比较不同镇痛药物对呼吸力学的影响及疗效差异。另外，将其中37例腹部术后患者进一步分为舒芬太尼亚组（n=17）和羟考酮亚组（n=20），进行组间比较。

组别与时间对呼吸力学指标及氧合通气指标均不存在交互效应（P>0.05），组别对以上指标主效应不显著（P>0.05），时间对Ppeak、MP、VR主效应显著（P<0.05）。两组24 h镇痛药物吗啡效价换算总剂量、24 h镇静药物丙泊酚使用总剂量、机械通气时间及ICU-LOS比较，差异均无统计学意义（P>0.05）。腹部术后分析发现，羟考酮亚组镇静药物24 h丙泊酚使用剂量少于舒芬太尼亚组（P<0.05）。

羟考酮注射液同舒芬太尼注射液均能有效改善ICU机械通气患者的呼吸力学参数和氧合通气指标，对实施肺保护性通气、降低VILI风险具有显著意义；针对腹部术后的机械通气患者，羟考酮注射液在有效镇痛的同时可减少镇静药物用量，降低高剂量镇静带来的临床风险，安全性更高。