羟考酮在腹腔镜胆囊切除术麻醉中的效果及安全性
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摘要
目的探讨羟考酮用于腹腔镜胆囊切除术麻醉中的安全性和有效性。方法选择行腹腔镜胆囊切除术的患者80例,随机分为对照组和观察组,每组各40例。对照组麻醉诱导时静脉注射舒芬太尼0.2μg/kg、丙泊酚2mg/kg与顺式阿曲库铵0.15mg/kg,观察组麻醉诱导时静脉注射羟考酮0.2mg/kg、丙泊酚2 mg/kg与顺式阿曲库铵0.15mg/kg。术中麻醉维持均采用丙泊酚联合瑞芬太尼靶控输注。记录两组患者术中瑞芬太尼和丙泊酚用量及麻醉时间、苏醒时间、拔管时间,记录拔管后1、4、8、12小时的VAS评分及不良反应发生情况。于麻醉前、术后1、4、8小时测定血清中血糖和皮质醇水平。结果两组患者术中瑞芬太尼和丙泊酚用量及麻醉时间、苏醒时间、拔管时间差异无统计学意义(P>0.05);观察组术后1、4小时的VAS评分、血糖和皮质醇水平明显低于对照组(P<0.05);两组出现苏醒期躁动、恶心呕吐、头晕、呼吸抑制发生率比较差异无统计学意义(P>0.05)。结论羟考酮能安全有效的用于腹腔镜胆囊切除手术麻醉,且不良反应少,可在临床推广应用。
Objective To observe the effect and safety of oxycodone in patients undergoing laparoscopic cholecystectomy. Methods 80 patients undergoing laparoscopic cholecystectomy were randomly divided into two groups, with 40 cases in each group. The control group was treated with sufentanil 0.2μg/kg + propofol 2 mg/kg+ cisatracurium 0.15 mg/kg for anesthesia induction, while the observation group was treated with oxycodone0.2 mg/kg + propofol 2 mg/kg+ cisatracurium 0.15 mg/kg for anesthesia induction. Propofol target-controlled infusion combined with remifentanil were used for maintenance of general anesthesia during the operation. Total consumption of propofol and remifentanil, anesthesia time, awake time and extubation time were recorded. The adverse events and VAS score at 1 h, 4 h, 8 h, and 12 h after operation were observed. Glucose and serum cortisol were also measured before the operation and at 1 h, 4 h, 8 h after the operation. Results There was no significant difference between groups in consumption of propofol and remifentanil and anesthesia time, awake time, extubation time. The VAS scores, glucose and serum cortisol at 1 h,4 h after operation of observation group were lower than that in control group(P<0.05). There was no significant difference between groups in the rate of complication. Conclusion Oxycodone can be used for laparoscopic cholecystectomy safely and effectively with less adverse reactions.
Objective To observe the effect and safety of oxycodone in patients undergoing laparoscopic cholecystectomy. Methods 80 patients undergoing laparoscopic cholecystectomy were randomly divided into two groups, with 40 cases in each group. The control group was treated with sufentanil 0.2μg/kg + propofol 2 mg/kg+ cisatracurium 0.15 mg/kg for anesthesia induction, while the observation group was treated with oxycodone0.2 mg/kg + propofol 2 mg/kg+ cisatracurium 0.15 mg/kg for anesthesia induction. Propofol target-controlled infusion combined with remifentanil were used for maintenance of general anesthesia during the operation. Total consumption of propofol and remifentanil, anesthesia time, awake time and extubation time were recorded. The adverse events and VAS score at 1 h, 4 h, 8 h, and 12 h after operation were observed. Glucose and serum cortisol were also measured before the operation and at 1 h, 4 h, 8 h after the operation. Results There was no significant difference between groups in consumption of propofol and remifentanil and anesthesia time, awake time, extubation time. The VAS scores, glucose and serum cortisol at 1 h,4 h after operation of observation group were lower than that in control group(P<0.05). There was no significant difference between groups in the rate of complication. Conclusion Oxycodone can be used for laparoscopic cholecystectomy safely and effectively with less adverse reactions.
引文
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[10] 相小松,李东虎,李向阳,等.加速康复外科与日间腹腔镜胆囊切除术的质量控制[J].腹腔镜外科杂志,2016(12):951-953.
[11] 王奎,付山.舒芬太尼联合丙泊酚静脉麻醉在腹腔镜胆囊切除术中的麻醉作用研究[J].药物评价研究,2017,40(2):252-254.
[12] 朱苗苗,黄科昌,陈乃葆,等.羟考酮硬膜外自控镇痛对剖宫产术后内脏痛的镇痛效果观察[J].潍坊医学院学报,2016(5):333-335.
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[15] 喻红彪,李刚,陈玲.帕瑞昔布钠联合舒芬太尼镇痛对食管癌根治术患者镇痛效果及炎症反应的影响[J].广东医学,2013,34(24):3784-3786.
[16] 陈宏.不同麻醉方法对胆囊切除术患者应激反应的影响[J].西部医学,2008,20(2):348-349.
[17] 陈适,彭秀兰,易能芬.不同麻醉方法对老年腹腔镜胆囊切除术患者应激反应的影响[J].浙江创伤外科,2016,21(2):390-392.
[18] 张海山,王大龙,左振芳,等.Supreme 喉罩与气管插管对老年高血压患者人工膝关节置换术应激反应的影响[J].临床麻醉学杂志,2014(6):577-580.
[19] 王志红,赵莉,杨毅,等.盐酸羟考酮联合帕瑞昔布钠对瑞芬太尼复合麻醉患者手术后痛觉过敏的影响[J].医药导报,2016,35(9):978-981.
[20] 王金兰,赵国庆,刘岩,等.异丙酚和七氟醚麻醉诱导插管时血糖、皮质醇的变化[J].中国实验诊断学,2007,11(9):1172-1173.
[2] 李永军,杨建军.喷他佐辛和吗啡用于剖宫产术后硬膜外镇痛的效果比较[J].现代中西医结合杂志,2010,19(5):599-599.
[3] 阮履强,王利洋,王洪阳,等.布托啡诺复合舒芬太尼用于脊柱外科术后静脉镇痛的临床观察[J].西部医学,2013,25(8):1181-1182.
[4] 徐建国.盐酸羟考酮的药理学和临床应用[J].临床麻醉学杂志,2014,30(5):511-513.
[5] 姚月勤,范志毅.羟考酮注射液联合帕瑞昔布钠治疗瑞芬太尼复合麻醉术后疼痛的疗效观察[J].中国疼痛医学杂志,2016,22(12):919-922.
[6] 王特,朱瑞新,田川,等.具有μ/δ双重功效的阿片受体激动剂中药成分筛选研究[J].辽宁中医药大学学报,2014,2(16):46-50.
[7] 徐运章.不同镇痛方法应用于腰椎开窗术后患者的效果观察[J].西部医学,2011,23(1):123-124.
[8] 吴卫国,程平,刘安成,等.腹腔镜胆囊切除术与传统开腹胆囊切除术治疗胆囊结石临床疗效比较[J].肝胆外科杂志,2013,21(6):457-458.
[9] 王辉,王坚.加速康复外科理念指导下的日间腹腔镜胆囊切除术1400例分析[J].肝胆胰外科杂志,2017,29(1):6-9.
[10] 相小松,李东虎,李向阳,等.加速康复外科与日间腹腔镜胆囊切除术的质量控制[J].腹腔镜外科杂志,2016(12):951-953.
[11] 王奎,付山.舒芬太尼联合丙泊酚静脉麻醉在腹腔镜胆囊切除术中的麻醉作用研究[J].药物评价研究,2017,40(2):252-254.
[12] 朱苗苗,黄科昌,陈乃葆,等.羟考酮硬膜外自控镇痛对剖宫产术后内脏痛的镇痛效果观察[J].潍坊医学院学报,2016(5):333-335.
[13] Hao G T,Zhou H Y,Gao H Z,et al.Pharmacokinetics of oxycodone hydrochloride and three of its metabolites after intravenous administration in Chinese patients with pain[J].Pharmacological Reports Pr,2014,66(1):153-158.
[14] 朱文智,王东信.羟考酮在全身麻醉诱导中的临床应用[J].临床麻醉学杂志,2016,32(4):341-343.
[15] 喻红彪,李刚,陈玲.帕瑞昔布钠联合舒芬太尼镇痛对食管癌根治术患者镇痛效果及炎症反应的影响[J].广东医学,2013,34(24):3784-3786.
[16] 陈宏.不同麻醉方法对胆囊切除术患者应激反应的影响[J].西部医学,2008,20(2):348-349.
[17] 陈适,彭秀兰,易能芬.不同麻醉方法对老年腹腔镜胆囊切除术患者应激反应的影响[J].浙江创伤外科,2016,21(2):390-392.
[18] 张海山,王大龙,左振芳,等.Supreme 喉罩与气管插管对老年高血压患者人工膝关节置换术应激反应的影响[J].临床麻醉学杂志,2014(6):577-580.
[19] 王志红,赵莉,杨毅,等.盐酸羟考酮联合帕瑞昔布钠对瑞芬太尼复合麻醉患者手术后痛觉过敏的影响[J].医药导报,2016,35(9):978-981.
[20] 王金兰,赵国庆,刘岩,等.异丙酚和七氟醚麻醉诱导插管时血糖、皮质醇的变化[J].中国实验诊断学,2007,11(9):1172-1173.