盐酸羟考酮注射液预处理在肺癌根治术中的应用效果及对机体免疫功能的影响
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摘要
目的探讨肺癌根治术中实施盐酸羟考酮注射液预处理对患者术后疼痛、术中不良反应及免疫功能的影响。方法选取84例肺癌患者为研究对象,行肺癌根治手术治疗,均选择气管插管全身麻醉。以随机数字表法将84例患者分为对照组42例,观察组42例。对照组于麻醉诱导前5 min给予0.08 mg/kg氯化钠注射液预处理;观察组于麻醉诱导前5 min给予0.08 mg/kg盐酸羟考酮注射液预处理。观察两组患者术中低血压、心动过缓、呼吸抑制等不良反应发生情况,术中阿片类药物使用剂量,手术时间,术后2 h、术后6 h、术后12 h疼痛程度及手术前后免疫功能指标变化。结果观察组术中不良反应发生率为7.14%,对照组术中不良反应发生率为23.81%,差异有统计学意义(P<0.05);观察组术后2 h及术后6 h视觉模拟评分法(VAS)评分同对照组比较,明显较低,差异有统计学意义(P<0.05),术后12 h两组VAS评分差异无统计学意义(P>0.05),两组患者术中阿片类药物使用剂量及手术时间差异无统计学意义(P>0.05);两组患者术前免疫功能相关指标差异无统计学意义(P>0.05),术后均有改变,观察组术后CD4+、CD4+/CD8+同对照组比较,显著较高,CD8+同对照组比较,明显较低,差异有统计学意义(P<0.05)。结论肺癌根治术中实施盐酸羟考酮注射液预处理,可有效减轻患者术后疼痛,提高手术安全性,并对预防免疫功能紊乱方面有积极作用。
Objective To explore the effect of oxycodone hydrochloride injection pretreatment on the immune function,adverse reaction and postoperative pain in patients with lung cancer radical surgery. Methods Eighty cases of lung cancerd with radical surgery were selected,and all patients were selected for general anesthesia by tracheal intubation. All patients were divided into control group( n = 42) and observation group( n = 42) by random number table method,the control group were pretreatment with 0. 08 mg/kg Sodium Chloride Injection 5 min before induction of anesthesia,observed were pretreatment by 0. 08 mg/kg oxycodone hydrochloride injection. The incidence of intraoperative hypotension,bradycardia,respiratory depression and other adverse reactions in two groups were observed. The opioid dosage,operative time,2 h,6 h and 12 h postoperative pain and the immune function before and after operation were recorded. Results The incidence of adverse reactions was 7. 14% in the observation group,and the incidence of adverse reactions was 23. 81% in the control group,and the difference was statistically significant( P < 0. 05). Compared with the control group,the VAS score of observation group at 2 h and 6 h postoperative,were lower,the difference was statistically significant( P < 0. 05),VAS scores of 12 h postoperative had no statistical difference between the two groups( P >0. 05),Opioid dosage and operative time had no significant difference between the two groups( P > 0. 05). There was no significant difference in immune function between the two groups( P > 0. 05),but there was a significant change after operation. The CD4+and CD4+/CD8+in the observation group were significantly higher than those in the control group. CD8+was significantly lower than that in the control group( P < 0. 05). Conclusion The oxycodone hydrochloride injection pretreatment can effectively reduce postoperative pain,improve the safety of operation and immune function in patients with lung cancer radical surgery.
Objective To explore the effect of oxycodone hydrochloride injection pretreatment on the immune function,adverse reaction and postoperative pain in patients with lung cancer radical surgery. Methods Eighty cases of lung cancerd with radical surgery were selected,and all patients were selected for general anesthesia by tracheal intubation. All patients were divided into control group( n = 42) and observation group( n = 42) by random number table method,the control group were pretreatment with 0. 08 mg/kg Sodium Chloride Injection 5 min before induction of anesthesia,observed were pretreatment by 0. 08 mg/kg oxycodone hydrochloride injection. The incidence of intraoperative hypotension,bradycardia,respiratory depression and other adverse reactions in two groups were observed. The opioid dosage,operative time,2 h,6 h and 12 h postoperative pain and the immune function before and after operation were recorded. Results The incidence of adverse reactions was 7. 14% in the observation group,and the incidence of adverse reactions was 23. 81% in the control group,and the difference was statistically significant( P < 0. 05). Compared with the control group,the VAS score of observation group at 2 h and 6 h postoperative,were lower,the difference was statistically significant( P < 0. 05),VAS scores of 12 h postoperative had no statistical difference between the two groups( P >0. 05),Opioid dosage and operative time had no significant difference between the two groups( P > 0. 05). There was no significant difference in immune function between the two groups( P > 0. 05),but there was a significant change after operation. The CD4+and CD4+/CD8+in the observation group were significantly higher than those in the control group. CD8+was significantly lower than that in the control group( P < 0. 05). Conclusion The oxycodone hydrochloride injection pretreatment can effectively reduce postoperative pain,improve the safety of operation and immune function in patients with lung cancer radical surgery.
引文
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[9]RICHARDS P,GIMBEL JS,MINKOWITZ HS,et al.Comparison of the efficacy and safety of dual-opioid treatment with morphine plus oxycodone versus oxycodone/acetaminophen for moderate to severe acute pain after total knee arthroplasty[J].Clin ther,2013,35(4):498-511.
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[11]HAO GT,ZHOU H Y,GAO HZ,et al.Pharmacokinetics of oxycodone hydrochloride and three of its metabolites after intravenous administration in Chinese patients with pain[J].Pharmacol Rep,2014,66(1):153-158.
[12]MCCLOSKEY LJ,DELLABADIA KA,STICKLE DF.Receiver-operating characteristics of adjusted urine measurements of oxycodone plus metabolites to distinguish between three different rates of oxycodone administration[J].Clin Biochem,2013,46(1/2):115-118.
[13]KOKKI M,VALITALO P,KUUSISTO M,et al.Central nervous system penetration of oxycodone after intravenous and epidural administration[J].Br J Anaesth,2014,112(1):133-140.
[14]KLIMAS R,WITTICKE D,ELFALLAH S,et al.Contribution of oxycodone and its metabolites to the overall analgesic effect after oxycodone administration[J].Expert Opin Drug,2013,9(5):517-528.
[15]BHALLA S,ALI I,LEE H,et al.Potentiation of oxycodone antinociception in mice by agmatine and BMS182874 via an imidazoline I2 receptor-mediated mechanism[J].Pharmacol Biochem Behav,2013,103(3):550-560.
[16]GOSAI P,DUCHARME MP,GODFREY AR,et al.Bioequivalence of oxycodone hydrochoride extended release tablets to marketed reference products Oxycontin in Canada and US[J].Int J Clin Pharmacol Ther,2013,51(11):895-907.
[17]ROUX P,SULLIVAN MA,COHEN J,et al.Buprenorphine/naloxone as a promising therapeutic option for opioid abusing patients with chronic pain:Reduction of pain,opioid withdrawal symptoms,and abuse liability of oral oxycodone[J].Pain,2013,154(8):1442-1448.
[18]NAITO T,TASHIRO M,ISHIDA T,et al.Cancer cachexia raises the plasma concentration of oxymorphone through the reduction of CYP3A but not CYP2D6 in oxycodonetreated patients[J].J Clin Pharmacol,2013,53(8):812-818.
[19]CEPEDA MS,FIFE D,MA Q,et al.Comparison of the risks of opioid abuse or dependence between tapentadol and oxycodone:Results from a cohort study[J].J Pain,2013,14(10):1227-1241.
[2]郭建极,何巍,周华富,等.老年肺癌伴糖尿病患者的围手术期处理[J].中国临床保健杂志,2006,9(3):258-259.
[3]靖国庆,范钧钊,任瑶瑶,等.羟考酮预处理对大鼠肠缺血再灌注诱发肝损伤的影响及不同阿片受体在其中的作用[J].中华麻醉学杂志,2015,35(10):1271-1273.
[4]邓雪峰,朱延浩,常启敏,等.羟考酮预处理在骨折术后镇痛中的作用及效果观察[J].疑难病杂志,2017,16(2):168-171.
[5]张正华,魏大中,徐美清,等.老年非小细胞肺癌患者术后生存期的研究[J].中国临床保健杂志,2010,13(2):158-160.
[6]支修益,石远凯,于金明,等.中国原发性肺癌诊疗规范(2015年版)[J].中华肿瘤杂志,2015,37(1):67-78.
[7]武春银,王瑞婷,疏树华,等.不同剂量羟考酮预处理对体外循环心脏手术患者血流动力学及围术期炎性因子的影响[J].山东医药,2017,57(20):65-68.
[8]马玉恒,刘中光,李永旺,等.盐酸羟考酮预处理对依托咪酯所致肌阵挛的影响[J].中国医药导报,2015,12(16):124-127.
[9]RICHARDS P,GIMBEL JS,MINKOWITZ HS,et al.Comparison of the efficacy and safety of dual-opioid treatment with morphine plus oxycodone versus oxycodone/acetaminophen for moderate to severe acute pain after total knee arthroplasty[J].Clin ther,2013,35(4):498-511.
[10]COPLAN PM,KALE H,SANDSTROM L,et al.Changes in oxycodone and heroin exposures in the National Poison Data System after introduction of extended-release oxycodone with abuse-deterrent characteristics[J].Pharmacoepidemiol Drug Saf,2013,22(12):1274-1282.
[11]HAO GT,ZHOU H Y,GAO HZ,et al.Pharmacokinetics of oxycodone hydrochloride and three of its metabolites after intravenous administration in Chinese patients with pain[J].Pharmacol Rep,2014,66(1):153-158.
[12]MCCLOSKEY LJ,DELLABADIA KA,STICKLE DF.Receiver-operating characteristics of adjusted urine measurements of oxycodone plus metabolites to distinguish between three different rates of oxycodone administration[J].Clin Biochem,2013,46(1/2):115-118.
[13]KOKKI M,VALITALO P,KUUSISTO M,et al.Central nervous system penetration of oxycodone after intravenous and epidural administration[J].Br J Anaesth,2014,112(1):133-140.
[14]KLIMAS R,WITTICKE D,ELFALLAH S,et al.Contribution of oxycodone and its metabolites to the overall analgesic effect after oxycodone administration[J].Expert Opin Drug,2013,9(5):517-528.
[15]BHALLA S,ALI I,LEE H,et al.Potentiation of oxycodone antinociception in mice by agmatine and BMS182874 via an imidazoline I2 receptor-mediated mechanism[J].Pharmacol Biochem Behav,2013,103(3):550-560.
[16]GOSAI P,DUCHARME MP,GODFREY AR,et al.Bioequivalence of oxycodone hydrochoride extended release tablets to marketed reference products Oxycontin in Canada and US[J].Int J Clin Pharmacol Ther,2013,51(11):895-907.
[17]ROUX P,SULLIVAN MA,COHEN J,et al.Buprenorphine/naloxone as a promising therapeutic option for opioid abusing patients with chronic pain:Reduction of pain,opioid withdrawal symptoms,and abuse liability of oral oxycodone[J].Pain,2013,154(8):1442-1448.
[18]NAITO T,TASHIRO M,ISHIDA T,et al.Cancer cachexia raises the plasma concentration of oxymorphone through the reduction of CYP3A but not CYP2D6 in oxycodonetreated patients[J].J Clin Pharmacol,2013,53(8):812-818.
[19]CEPEDA MS,FIFE D,MA Q,et al.Comparison of the risks of opioid abuse or dependence between tapentadol and oxycodone:Results from a cohort study[J].J Pain,2013,14(10):1227-1241.