摘要
目的结直肠癌根治术围术期镇痛药物的选择存在争议。文中旨在评价盐酸羟考酮注射液用于结直肠癌根治术中麻醉及术后镇痛的应用效果,为此类手术镇痛药物的选择提供依据。方法选择2017年7月至2017年12月于东部战区总医院择期行开腹结直肠癌根治术患者38例,年龄18~65岁,体重指数18~25 kg/m2,ASAⅡ~Ⅲ级。将纳入研究患者按照随机、单盲方法分为羟考酮组和舒芬太尼组,每组19例。2组患者分别在麻醉诱导时静脉注射羟考酮0.3 mg/kg和舒芬太尼0.3μg/kg。术中维持用药一致。临近术毕缝皮时羟考酮组患者静脉注射羟考酮0.15 mg/kg,舒芬太尼组患者静脉注射舒芬太尼0.15μg/kg。术毕接静脉镇痛(PCIA),记录术后拔管时(T1)、4 h(T2)、12 h(T3)、24 h(T4)和48 h(T5)疼痛数字评分(NRS评分)和Ramsay镇静评分。记录插管前后血浆皮质醇含量及心率、平均动脉压变化以及拔管时间、首次肠道通气时间、PCIA按压次数和不良反应的发生情况。结果2组患者年龄、体重、麻醉时间等差异均无统计学意义(P>0.05)。与舒芬太尼组患者比较,羟考酮组患者各时间点NRS分值均显著降低(P<0.05),T1、T2时Ramsay评分明显升高(P<0.05)。与插管前比较,插管后5 min两组患者血浆皮质醇含量均显著降低(P<0.05)。2组患者插管前后心率比较,差异无统计学意义(P>0.05)。与插管前比较,插管时及插管后5 min羟考酮组患者平均动脉压均明显降低(P<0.05);舒芬太尼组患者平均动脉压仅在插管后5 min显著降低(P<0.05)。与舒芬太尼组患者比较,羟考酮组患者苏醒拔管时间显著延长[(21.5±6.3)min vs(32.7±12.1)min,P<0.05],术后镇痛泵按压次数显著降低[(3.2±1.9)次vs(0.2±0.5)次,P<0.05]。术后首次肠道通气时间、恶心呕吐、呼吸抑制等不良反应组间差异均无统计学意义(P>0.05)。结论与舒芬太尼比较,羟考酮可更安全有效地用于结直肠癌根治术的全麻诱�
Objective The choice of perioperative analgesic drugs for radical resection of colorectal cancer is controversial.The purpose of this paper is to investigate the efficacy of oxycodone hydrochloride injection on anesthesia and postoperative analgesia in patients with radical resection of colorectal cancer,to provide a ba-Methods Be-tween July 2017 and December 2017,selection of 38 patients with colorectal cancer underwent elective open surgical operation in the Eastern Theater General Hospital,the age range was 18~65 years,the BMI range was 18~25 kg/m^2,the ASA wasⅡorⅢgrade,who were divided to two groups according to randomized,single blind and controlled methods,the oxycodone group was group O,the sufentanil was group S,each group had 19 cases.Oxycodone 0.3 mg/kg(group O)and sufentanil 0.3μg/kg(group S)were given at general anesthesia induction in both groups.The anesthesia maintenance medication was consistent in both groups.When sewing skin,the group O were given oxycodone 0.15 mg/kg,the group S were given sufentanil 0.15μg/kg,and who were given PCIA postoperative,the group O were given oxycodone 1 mg/kg and Azhasi 10 mg,while the group S were given sufentanil 2.5μg/kg and Azhasi 10 mg,which were diluted with normal saline to 100 mL.The NRS score post-operative and the Ramsay sedation scores were recorded when extubating(T1),4 hours after operation(T2),12 hours after operation(T3),24 hours after operation(T4)and 48 hours after operation(T5)in two groups;the plasma cortisol,MAP(mean arterial pressure)and HR(heart rate)before and after intubation in two groups were recorded;the extubation time,first bowel ventilation time,PCIA compressions and adverse reactions in two groups were recorded.Results The age,weight,anesthesia duration had no significant difference in two groups(P>0.05).Compared with group S,the NRS scores were obvious decreased in group O at all time points(P<0.05),the Ramsay score were obvious higher at T1 and T2(P<0.05).Compared with before inptubation,the plasma cortisol in two groups were
作者
曹林
田蜜
张利东
CAO Lin;TIAN Mi;ZHANG Li-dong(Department of Anesthesiology,General Hospital of Eastern Theater Command,PLA,Nanjing 210002,Jiangsu,China)
出处
《医学研究生学报》
CAS
北大核心
2019年第12期1296-1300,共5页
Journal of Medical Postgraduates
基金
南京军区医药卫生科研基金(14ZX15)
关键词
羟考酮
全麻诱导
皮质醇
结直肠癌根治术
oxycodone
anesthesia induction
cortisol
radical resection of colorectal cancer
