摘要
目的比较羟考酮和地佐辛用于妇科腔镜手术超前镇痛的效果。方法全身麻醉下妇科腹腔镜手术患者200例，随机分为羟考酮组和地佐辛组，各100例。气腹前10min，2组分别给予羟考酮0．1mg／kg、地佐辛0．1mg／kg。记录麻醉后5min（TO）、气腹后1min（T1）、气腹后5min改变体位时（T2）、气腹后15min（T3）、气腹结束恢复体位后lmin（T4）、5min（T5）时血液流变学指标，以及术后1、2、6、12、24、48h时静息、运动疼痛视觉模拟（VAS）评分。并观察术后不良反应及术后内脏痛的发生情况。在术后12h留取血液标本，分别采用ELISA方法检测患者血清炎性因子的表达水平。结果T1，T2时地佐辛组的HR、MAP明显高于羟考酮纽（P〈0．05），TI-T3时地佐辛组的CVP、CO明显低于羟考酮组（P〈0．05），T1-T5时地佐辛组的svR明显高于羟考酮组（P〈0．05），羟考酮组腹腔镜术后疼痛综合征发生率明显低于地佐辛组（P〈0．05），2组其他不良反应的发生率差异无统计学意义。羟考酮组患者术后血清TNF-d与IL-6表达水平明显低于地佐辛组（P〈0．05）；而IL—10表达水平明显高于地佐辛组（P〈0．05）。结论羟考酮超前镇痛用于妇科腹腔镜手术，术中对血流动力学影响较小，缓解内脏牵拉所致腹腔镜术后疼痛综合症，更好地促进抗炎因子表达，抑制促炎因子表达，维护炎性因子平衡，且效果优于地佐辛。
Objective To compare the preemptive analgesia effect of oxycodone and dezocine in patients for gynecological endoscopy surgery and their influence on the inflammatory cytokines. Methods 200 patients who underwent elective gynecological laparoscopic operation were randomly divided into two groups. Oxycodone group （ group O ） were given oxycodone 0.1 mg/kg, dezocine group （ group D ） were given dezocine 0.1 mg/kg in 10 min before pneumoperitoneum, the blood rheology indexes of 5 min after anesthesia records （ TO ） , 1 min after pneumoperitoneum （ T1 ） , 5 min after pneumoperitoneum change position （ T2 ） , 15 min （ T3 ） , after the pneumoperitoneum recovery position 1 rain （ T4 ） , 5 rain （ T5 ） were recorded respectively in both two groups. Results There were significant differences in HR and MAP between two groups at T1, T2. The indexes of CVP and CO were significantly lower in group O than that of group D （ P〈0.05 ） at T1 -T3. The index of SVR was significantly lower in group D than that of group O （ P〈0.05 ） at TI-T5. There were no significant difference in the incidence of untoward effect between the two groups （P〉0.05 ） . The level of serum TNF alpha and IL-6 expression were significantly lower in group D than that of group O （ P〈0.05 ） .The level of serum IL- 10 expression level was significantly higher in group D than that of group O （ P〈0.05 ） . Conclusion Oxycodone has a preemptive analgesia effects for gynecological laparoscopic surgery, with less influence on hemodynamics intraoperatively, more relieved internal force caused by laparoscopic postoperative pain syndrome, better promotion on the anti-inflammatory factor expression, more inhibition of proinflammatory factor expression andbetter maintaining balance of inflammatory cytokines, making it better than dezocine.
出处
《浙江临床医学》
2016年第9期1622-1624,共3页
Zhejiang Clinical Medical Journal
