两种剂量的盐酸羟考酮注射液治疗乳腺癌改良根治术后急性疼痛患者的效果比较
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摘要
目的:探讨两种剂量的盐酸羟考酮注射液治疗乳腺癌改良根治术后急性疼痛患者的临床效果。方法:选取我院收治的120例择期全麻下行乳腺癌根治术治疗的患者进行研究,按照随机数字表法进行分组,60例患者为对照组,采用低剂量盐酸羟考酮注射液治疗,另60例为观察组,采用高剂量盐酸羟考酮注射液治疗,对比两组患者的镇痛效果、用药不良反应等。结果:两组患者在手术时间、麻醉时间、苏醒时间及拔管时间等指标方面对比均无较大差异性(P>0.05);拔除喉罩后5 min、0.5 h、2 h、4 h两组患者在疼痛程度评分方面(VAS)比较均无较大差异性(P>0.05),但拔除喉罩后8 h、12 h对比,观察组患者VAS评分明显低于对照组(P<0.05);两组患者在术后不良事件发生率及镇痛药物追加率方面对比均无较大差异性(P>0.05),麻醉前,两组患者心率、血压对比均无较大差异(P>0.05),给药后、苏醒期及恢复期两组各指标均有所变化,但两组间对比均无较大差异性(P>0.05)。结论:采用高剂量的盐酸羟考酮注射液对乳腺癌改良根治术后急性疼痛患者进行治疗效果显著,能够在改善患者术后急性疼痛程度的同时避免增加术后不良事件,可在临床上推广应用。
Objective:To investigate the clinical effects of two doses of oxycodone hydrochloride in the treatment of acute pain after modified radical mastectomy for breast cancer.Methods:A total of 120 patients undergoing elective general anesthesia underwent radical mastectomy were enrolled in our hospital.The patients were randomized to a randomized digital table.60 patients were treated with low-dose oxycodone hydrochloride.Sixty patients were treated with high dose oxycodone hydrochloride injection,and the analgesic effect and adverse drug reactions were compared between the two groups.Results:There were no significant differences in the operation time,anesthesia time,wake up time and extubation time between the two groups(P>0.05). The patients in the two groups were removed 5 min, 0.5 h,2 h,4 h after the laryngeal mask was removed.There was no significant difference in pain scores(VAS)(P>0.05),but the VAS scores of the observation group were significantly lower than those of the control group at 8 h and 12 h after removal of the laryngeal mask(P<0.05).There was no significant difference in the incidence of postoperative adverse events and the rate of analgesic drugs(P>0.05).Before anesthesia,there was no significant difference in heart rate and blood pressure between the two groups(P>0.05).There were changes in the indexes of the two groups after the administration,awakening period and recovery period,but there was no significant difference between the two groups(P>0.05).Conclusion:High-dose oxycodone hydrochloride injection is effective in the treatment of patients with acute pain after modified radical mastectomy.It can improve the postoperative acute pain level and avoid the increase of postoperative adverse events.It can be promoted clinically application.
Objective:To investigate the clinical effects of two doses of oxycodone hydrochloride in the treatment of acute pain after modified radical mastectomy for breast cancer.Methods:A total of 120 patients undergoing elective general anesthesia underwent radical mastectomy were enrolled in our hospital.The patients were randomized to a randomized digital table.60 patients were treated with low-dose oxycodone hydrochloride.Sixty patients were treated with high dose oxycodone hydrochloride injection,and the analgesic effect and adverse drug reactions were compared between the two groups.Results:There were no significant differences in the operation time,anesthesia time,wake up time and extubation time between the two groups(P>0.05). The patients in the two groups were removed 5 min, 0.5 h,2 h,4 h after the laryngeal mask was removed.There was no significant difference in pain scores(VAS)(P>0.05),but the VAS scores of the observation group were significantly lower than those of the control group at 8 h and 12 h after removal of the laryngeal mask(P<0.05).There was no significant difference in the incidence of postoperative adverse events and the rate of analgesic drugs(P>0.05).Before anesthesia,there was no significant difference in heart rate and blood pressure between the two groups(P>0.05).There were changes in the indexes of the two groups after the administration,awakening period and recovery period,but there was no significant difference between the two groups(P>0.05).Conclusion:High-dose oxycodone hydrochloride injection is effective in the treatment of patients with acute pain after modified radical mastectomy.It can improve the postoperative acute pain level and avoid the increase of postoperative adverse events.It can be promoted clinically application.
引文
[1] HE Shuangliang,GAN Jianhui,CAI Hai,et al.Effects of preemptive analgesia with oxycodone hydrochloride injection on postoperative analgesia after modified radical mastectomy for breast cancer[J].Medical Clinical Research,2017,34(2):256.[何双亮,甘建辉,蔡海,等.盐酸羟考酮注射液超前镇痛对乳腺癌改良根治术术后镇痛的影响[J].医学临床研究,2017,34(2):256.]
[2] Yao Yueqin,Fan Zhiyi.Efficacy of oxycodone injection combined with parecoxib in the treatment of pain after remifentanil combined anesthesia[J].Chinese Journal of Pain Medicine,2016,22(12):919-922.
[3] Z Chen,Y Xu,J Shu,et al.Breast-conserving surgery versus modified radical mastectomy in treatment of early stage breast cancer:A retrospective study of 107 cases[J].Journal of Cancer Research & Therapeutics,2015(5):29-31.
[4] LL Ferreira,A Lopez-Picado,L Lamata,et al.Postoperative analgesia by infusion of local anesthetic into the surgical wound after modified radical mastectomy:A randomized clinical trial[J].Plastic & Reconstructive Surgery,2014,134(6):862e-870e.
[5] LIAO Junfeng,TU Wenlong,YANG Na,et al.Clinical observation of oxycodone declination background infusion in postoperative analgesia in patients undergoing thoracoscopic lobectomy[J].Chinese Journal of Microscope,2017,23(3):14-19.[廖俊锋,屠文龙,杨娜,等.羟考酮递减法背景输注在胸腔镜肺叶切除患者术后镇痛中的临床效果观察[J].中国内镜杂志,2017,23(3):14-19.]
[6] YAO Fei,ZHANG Wenjing,XU Shaojun,et al.Effectiveness and safety of three different doses of oxycodone hydrochloride injection for uterine contraction pain after painless abortion[J].Journal of Clinical Medicine in Practice,2017,21(21):55-58.[姚飞,章文靖,许少军,等.三种不同剂量盐酸羟考酮注射液用于无痛人流术后宫缩痛的有效性和安全性[J].实用临床医药杂志,2017,21(21):55-58.]
[7] Cui Xiaoyan,Gan Jianhui.Comparison of different doses of oxycodone for postoperative intravenous analgesia in patients undergoing transurethral vaporization of the prostate[J].Hebei Medical Journal,2017,39(3):410-412.
[8] M Rohaizak,FJ Khan,JS Jasmin,et al.Ultracision versus electrocautery in performing modified radical mastectomy and axillary lymph node dissection for breast cancer:A prospective randomized control tria[J].Med J Malaysia,2013,68(3):204-207.
[9] WANG Yun,MIAO Changhong,Xu Pingbo.Effects of general anesthesia combined with intercostal nerve block on analgesia after modified radical mastectomy for breast cancer[J].Chinese Journal of Cancer,2015,25(7):544-548.[王芸,缪长虹,许平波.全麻复合肋间神经阻滞对乳腺癌改良根治术后镇痛效果的影响[J].中国癌症杂志,2015,25(7):544-548.]
[10] LI Ling,LU Yan,DUAN Fengmei,et al.Clinical analysis of flurbiprofen ester pretreatment on acute postoperative pain in breast cancer patients after remifentanil combined with propofol anesthesia[J].Shanxi Medical Journal,2016,45(16):1890-1892.[李玲,路艳,段凤梅,等.氟比洛芬酯预处理对瑞芬太尼复合异丙酚麻醉后乳腺癌患者手术后急性疼痛的临床影响分析[J].山西医药杂志,2016,45(16):1890-1892.]
[11] TAO Zhonglong,WU Yanwu.Effect of ropivacaine incision on postoperative pain in patients undergoing radical mastectomy[J].Chinese Journal of Physicians,2013,15(2):245-247.[陶中龙,吴言悟.罗哌卡因切口浸润对乳腺癌根治术患者术后疼痛的影响[J].中国医师杂志,2013,15(2):245-247.]
[12] ZHU Chen,QIN Zaisheng,TAO Tao.Effect of ultrasound-guided septal thoracic paravertebral block combined with TIVA on postoperative pain in modified radical mastectomy for breast cancer[J].Journal of Third Military Medical University,2015,37(18):1875-1880.[朱晨,秦再生,陶涛.超声引导下间隔平面胸椎旁阻滞联合TIVA应用于乳腺癌改良根治术对术后疼痛的影响[J].第三军医大学学报,2015,37(18):1875-1880.]
[13] ZHANG Qiongyu,WANG Jianfeng,LIU Enyu,et al.Effect of oral pregabalin on pain after modified radical mastectomy in breast cancer[J].Chinese Journal of Modern General Surgery,2012,15(7):541-544.[张琼予,王建峰,刘恩宇,等.围术期口服普瑞巴林对乳腺癌改良根治术后疼痛的影响[J].中国现代普通外科进展,2012,15(7):541-544.]
[14] AR Mwakigonja,R Happiness,NA Mbembati,et al.The pattern of prognostic and risk indicators among women with breast cancer undergoing modified radical mastectomy in Dar es Salaam,Tanzania[J].Infectious Agents & Cancer,2016,11(1):1-10.
[15] LI Xinquan,LV Jing,JIN Zi.Clinical observation of oxycodone hydrochloride controlled release tablets and morphine sustained release tablets in the treatment of severe pain in advanced malignant tumors[J].Chinese Journal of Practical Diagnosis and Therapy,2013,27(12):1216-1217.[李新权,吕靖,金子.盐酸羟考酮控释片及硫酸吗啡缓释片治疗晚期恶性肿瘤重度疼痛临床观察[J].中华实用诊断与治疗杂志,2013,27(12):1216-1217.]
[16] L Zhang,A Fan,J Yan,et al.Combining manual lymph drainage with physical exercise after modified radical Mastectomy effectively prevents upper limb lymphedema[J].Lymphatic Research & Biology,2016,14(2):104.
[17] LI Ning,ZHANG Chunyan,ZHANG Jiaqiang.Effects of different doses of oxycodone hydrochloride on pain during anesthesia recovery in patients undergoing laparoscopic radical resection of colon cancer[J].Chinese Journal of Practical Diagnosis and Therapy,2016,30(8):818-820.[李宁,张春艳,张加强.不同剂量盐酸羟考酮对行手助腹腔镜结肠癌根治术患者麻醉苏醒期疼痛的影响[J].中华实用诊断与治疗杂志,2016,30(8):818-820.]
[18] SUN Yi,LI Li,ZHANG Minghui,et al.Comparison of the efficacy and safety of super high dose of oxycodone hydrochloride prolonged-release tablets and morphine sulfate sustained-release tablets in the treatment of serious cancer pain[J].Modern Oncology,2017,25(22):3683-3687.[孙薏,李莉,张明慧,等.超大剂量盐酸羟考酮缓释片与硫酸吗啡缓释片治疗重度癌痛的疗效及安全性比较[J].现代肿瘤医学,2017,25(22):3683-3687.]
[19] QI Chao,SUN Xiaoke,BI Yanmin,et al.Effects of different doses of oxycodone hydrochloride injection on patient-controlled analgesia in patients undergoing ureteroscopic lithotripsy[J].Anhui Medical Journal,2017,38(11):1479-1482.[齐超,孙小可,毕艳敏,等.不同剂量盐酸羟考酮注射液对输尿管镜碎石取石术患者自控镇痛的影响[J].安徽医学,2017,38(11):1479-1482.]
[2] Yao Yueqin,Fan Zhiyi.Efficacy of oxycodone injection combined with parecoxib in the treatment of pain after remifentanil combined anesthesia[J].Chinese Journal of Pain Medicine,2016,22(12):919-922.
[3] Z Chen,Y Xu,J Shu,et al.Breast-conserving surgery versus modified radical mastectomy in treatment of early stage breast cancer:A retrospective study of 107 cases[J].Journal of Cancer Research & Therapeutics,2015(5):29-31.
[4] LL Ferreira,A Lopez-Picado,L Lamata,et al.Postoperative analgesia by infusion of local anesthetic into the surgical wound after modified radical mastectomy:A randomized clinical trial[J].Plastic & Reconstructive Surgery,2014,134(6):862e-870e.
[5] LIAO Junfeng,TU Wenlong,YANG Na,et al.Clinical observation of oxycodone declination background infusion in postoperative analgesia in patients undergoing thoracoscopic lobectomy[J].Chinese Journal of Microscope,2017,23(3):14-19.[廖俊锋,屠文龙,杨娜,等.羟考酮递减法背景输注在胸腔镜肺叶切除患者术后镇痛中的临床效果观察[J].中国内镜杂志,2017,23(3):14-19.]
[6] YAO Fei,ZHANG Wenjing,XU Shaojun,et al.Effectiveness and safety of three different doses of oxycodone hydrochloride injection for uterine contraction pain after painless abortion[J].Journal of Clinical Medicine in Practice,2017,21(21):55-58.[姚飞,章文靖,许少军,等.三种不同剂量盐酸羟考酮注射液用于无痛人流术后宫缩痛的有效性和安全性[J].实用临床医药杂志,2017,21(21):55-58.]
[7] Cui Xiaoyan,Gan Jianhui.Comparison of different doses of oxycodone for postoperative intravenous analgesia in patients undergoing transurethral vaporization of the prostate[J].Hebei Medical Journal,2017,39(3):410-412.
[8] M Rohaizak,FJ Khan,JS Jasmin,et al.Ultracision versus electrocautery in performing modified radical mastectomy and axillary lymph node dissection for breast cancer:A prospective randomized control tria[J].Med J Malaysia,2013,68(3):204-207.
[9] WANG Yun,MIAO Changhong,Xu Pingbo.Effects of general anesthesia combined with intercostal nerve block on analgesia after modified radical mastectomy for breast cancer[J].Chinese Journal of Cancer,2015,25(7):544-548.[王芸,缪长虹,许平波.全麻复合肋间神经阻滞对乳腺癌改良根治术后镇痛效果的影响[J].中国癌症杂志,2015,25(7):544-548.]
[10] LI Ling,LU Yan,DUAN Fengmei,et al.Clinical analysis of flurbiprofen ester pretreatment on acute postoperative pain in breast cancer patients after remifentanil combined with propofol anesthesia[J].Shanxi Medical Journal,2016,45(16):1890-1892.[李玲,路艳,段凤梅,等.氟比洛芬酯预处理对瑞芬太尼复合异丙酚麻醉后乳腺癌患者手术后急性疼痛的临床影响分析[J].山西医药杂志,2016,45(16):1890-1892.]
[11] TAO Zhonglong,WU Yanwu.Effect of ropivacaine incision on postoperative pain in patients undergoing radical mastectomy[J].Chinese Journal of Physicians,2013,15(2):245-247.[陶中龙,吴言悟.罗哌卡因切口浸润对乳腺癌根治术患者术后疼痛的影响[J].中国医师杂志,2013,15(2):245-247.]
[12] ZHU Chen,QIN Zaisheng,TAO Tao.Effect of ultrasound-guided septal thoracic paravertebral block combined with TIVA on postoperative pain in modified radical mastectomy for breast cancer[J].Journal of Third Military Medical University,2015,37(18):1875-1880.[朱晨,秦再生,陶涛.超声引导下间隔平面胸椎旁阻滞联合TIVA应用于乳腺癌改良根治术对术后疼痛的影响[J].第三军医大学学报,2015,37(18):1875-1880.]
[13] ZHANG Qiongyu,WANG Jianfeng,LIU Enyu,et al.Effect of oral pregabalin on pain after modified radical mastectomy in breast cancer[J].Chinese Journal of Modern General Surgery,2012,15(7):541-544.[张琼予,王建峰,刘恩宇,等.围术期口服普瑞巴林对乳腺癌改良根治术后疼痛的影响[J].中国现代普通外科进展,2012,15(7):541-544.]
[14] AR Mwakigonja,R Happiness,NA Mbembati,et al.The pattern of prognostic and risk indicators among women with breast cancer undergoing modified radical mastectomy in Dar es Salaam,Tanzania[J].Infectious Agents & Cancer,2016,11(1):1-10.
[15] LI Xinquan,LV Jing,JIN Zi.Clinical observation of oxycodone hydrochloride controlled release tablets and morphine sustained release tablets in the treatment of severe pain in advanced malignant tumors[J].Chinese Journal of Practical Diagnosis and Therapy,2013,27(12):1216-1217.[李新权,吕靖,金子.盐酸羟考酮控释片及硫酸吗啡缓释片治疗晚期恶性肿瘤重度疼痛临床观察[J].中华实用诊断与治疗杂志,2013,27(12):1216-1217.]
[16] L Zhang,A Fan,J Yan,et al.Combining manual lymph drainage with physical exercise after modified radical Mastectomy effectively prevents upper limb lymphedema[J].Lymphatic Research & Biology,2016,14(2):104.
[17] LI Ning,ZHANG Chunyan,ZHANG Jiaqiang.Effects of different doses of oxycodone hydrochloride on pain during anesthesia recovery in patients undergoing laparoscopic radical resection of colon cancer[J].Chinese Journal of Practical Diagnosis and Therapy,2016,30(8):818-820.[李宁,张春艳,张加强.不同剂量盐酸羟考酮对行手助腹腔镜结肠癌根治术患者麻醉苏醒期疼痛的影响[J].中华实用诊断与治疗杂志,2016,30(8):818-820.]
[18] SUN Yi,LI Li,ZHANG Minghui,et al.Comparison of the efficacy and safety of super high dose of oxycodone hydrochloride prolonged-release tablets and morphine sulfate sustained-release tablets in the treatment of serious cancer pain[J].Modern Oncology,2017,25(22):3683-3687.[孙薏,李莉,张明慧,等.超大剂量盐酸羟考酮缓释片与硫酸吗啡缓释片治疗重度癌痛的疗效及安全性比较[J].现代肿瘤医学,2017,25(22):3683-3687.]
[19] QI Chao,SUN Xiaoke,BI Yanmin,et al.Effects of different doses of oxycodone hydrochloride injection on patient-controlled analgesia in patients undergoing ureteroscopic lithotripsy[J].Anhui Medical Journal,2017,38(11):1479-1482.[齐超,孙小可,毕艳敏,等.不同剂量盐酸羟考酮注射液对输尿管镜碎石取石术患者自控镇痛的影响[J].安徽医学,2017,38(11):1479-1482.]