羟考酮用于老年患者腹腔镜胆囊切除术麻醉的可行性研究
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摘要
目的探讨盐酸羟考酮麻醉诱导用于老年患者胆囊手术的可行性。方法择期腹腔镜下胆囊切除术老年患者60例,年龄65~80岁,ASA分级Ⅰ~Ⅲ级。采用数字表法随机分为盐酸羟考酮诱导组(O组)和舒芬太尼诱导组(S组),每组各30例。O组盐酸羟考酮诱导剂量为0.3mg/kg,S组舒芬太尼为0.3μg/kg,给药5 min后进行气管插管,其余诱导药物相同。于诱导前(T_0)、气管导管进入声门(T_1)、插管后1、3和5min(T_(2、3、4))采动脉血,测定血浆肾上腺素、去甲肾上腺素和皮质醇浓度;并记录相应时间点平均动脉压(MAP)和心率(HR)。术毕复苏室观察拔除气管导管5、10、15、30min呼吸状态改变、呼吸抑制发生率和疼痛评分。结果两组间各时点MAP和HR比较差异无统计学意义(P>0.05)。与T_0比较,O组和S组T_3和T_4时点血肾上腺素和去甲肾上腺素浓度均显著下降(P<0.05),而两组间各时点差异无统计意义(P>0.05)。与S组比较,O组拔管后5和10min呼吸频率较快(P<0.05),呼吸异常和SpO_2≤90%发生率显著降低(P<0.05,P<0.01);O组拔管后5、10和15min视觉模拟评分较S组显著下降。结论盐酸羟考酮可安全有效用于老年患者短小手术的麻醉诱导,能降低拔管后早期呼吸抑制的发生率。
Objective To study the feasibiltiy of oxycodone hydrochloride for anesthesia induction in elderly patients after laparoscopic cholecystectomy. Methods Sixty ASA physical status Ⅰ to Ⅲ elderly obese patients,aged 65-80 year,scheduled for elective laparoscopic cholecystectomy were randomly allocated into 2 groups( n = 30 each) : oxycodone group( group O) and sufentanil group( group S). Anesthetic induction dose of 0. 3 mg/kg oxycodone in group O and 0. 3μg/kg sufentanil in group S,when 5 minutes elapsed endotracheal intubation was initiated in both groups. Hemodynamic parameters of mean arterial pressure( MAP) and heart rate( HR) were recorded. Arterial blood sample was extracted for assaying the concentrations of plasma adrenaline,noradrenaline and cortisol at the following time points: before induction( T_0),tube entering glottis( T_1) and at 1,3 and 5 min after intubation( T_(2,3,4)). In postanesthesia care unit,the ventilation status,mild hypoxia were observed within 30 minutes after extubation. Visual analogue score was assessed every 5 minutes after extubation. Results There were no statistical significances about MAP and HR in different time points between the two groups.When compared to T_0,plasma concentration of adrenaline and noradrenaline in T_3 and T_4 markedly decreased( P < 0. 05),whereas no differencs were found between the two groups( P > 0. 05). In comparison with group S,group O had lower incidence of abnormal ventilation status and occurrence of SpO_2 below 90% in 5 min and 10 min after extubation. Moreover,visual analog scale of group O in 5,10 and15 min after extubation significantly reduced compared to them in group S. Conclusion Oxycodone hydrochloride is safe and effectiye in anesthesia induction for elderly patients performing laparoscopic cholecystectomy,which is associated with a lower incidence of early postoperative respiration depression.
Objective To study the feasibiltiy of oxycodone hydrochloride for anesthesia induction in elderly patients after laparoscopic cholecystectomy. Methods Sixty ASA physical status Ⅰ to Ⅲ elderly obese patients,aged 65-80 year,scheduled for elective laparoscopic cholecystectomy were randomly allocated into 2 groups( n = 30 each) : oxycodone group( group O) and sufentanil group( group S). Anesthetic induction dose of 0. 3 mg/kg oxycodone in group O and 0. 3μg/kg sufentanil in group S,when 5 minutes elapsed endotracheal intubation was initiated in both groups. Hemodynamic parameters of mean arterial pressure( MAP) and heart rate( HR) were recorded. Arterial blood sample was extracted for assaying the concentrations of plasma adrenaline,noradrenaline and cortisol at the following time points: before induction( T_0),tube entering glottis( T_1) and at 1,3 and 5 min after intubation( T_(2,3,4)). In postanesthesia care unit,the ventilation status,mild hypoxia were observed within 30 minutes after extubation. Visual analogue score was assessed every 5 minutes after extubation. Results There were no statistical significances about MAP and HR in different time points between the two groups.When compared to T_0,plasma concentration of adrenaline and noradrenaline in T_3 and T_4 markedly decreased( P < 0. 05),whereas no differencs were found between the two groups( P > 0. 05). In comparison with group S,group O had lower incidence of abnormal ventilation status and occurrence of SpO_2 below 90% in 5 min and 10 min after extubation. Moreover,visual analog scale of group O in 5,10 and15 min after extubation significantly reduced compared to them in group S. Conclusion Oxycodone hydrochloride is safe and effectiye in anesthesia induction for elderly patients performing laparoscopic cholecystectomy,which is associated with a lower incidence of early postoperative respiration depression.
引文
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8 Joppich R,Richards P,Kelen R,et al.Analgesic efficacy and tolerability of intravenous morphine versus combined intravenous morphine and oxycodone in a 2-center,randomized,double-blind,pilot trial of patients with moderate to severe pain after total hip replacement[J].Clin Ther,2012,34(8):1751-1760
9 姜慧芳,连燕虹,周惠丹,等.羟考酮抑制单肺通气患者双腔支气管导管插管反应的适宜剂量[J].中华麻醉学杂志,2015,35(9):1104-1106
10 Bluth T,Pelosi P,de Abreu MG.The obese patient undergoing nonbariatric surgery[J].Curr Opin Anaesthesiol,2016,29(3):421-429
11 钱祖超,张群,罗华梁.盐酸羟考酮用于腹腔镜直肠癌根治术患者镇痛效果的观察[J].中国临床药理学与治疗学,2015,20(5):587-590
12 Kim NS,Lee JS,Park SY,et al.Oxycodone versus fentanyl for intravenous patient-controlled analgesia after laparoscopic supracervical hysterectomy:A prospective,randomized,double-blind study[J].Medicine(Baltimore),2017,96(10):e6286
2 P9yhiaR,Vainio A,Kalso E.A review of oxycodone's clinical pharmacokinetics and pharmacodynamics[J].J Pain Symptom Manage,1993,8:63-67
3 Park YH,Lee SH,Lee OH,et al.Optimal dose of intravenous oxycodone for attenuating hemodynamic changes after endotracheal intubation in healthy patients:a randomized controlled trial[J].Medicine(Baltimore),2017,96(11):e6234
4 Chang SH,Maney KM,Phillips JP,et al.A comparison of the respiratory effects of oxycodone versus morphine:a randomised,doubleblind,placebo-controlled investigation[J].Anaesthesia,2010,65(10):1007-1012
5 Jiang ZM,Chen ZH,Fang XM.Sidestream capnographic monitoring reduces the incidence of arterial oxygen desaturation during propofol ambulatory anesthesia for surgical abortion[J].Med Sci Monit,2014,20:2336-2342
6 Schricker T,Carli F,Schreiber M,et al.Propofol/sufentanil anesthesia suppresses the metabolic and endocrine response during,not after,lower abdominal surgery[J].Anesth Analg,2000,90(2):450-455
7 Carron M,Veronese S,Gomiero W,et al.Hemodynamic and hormonal stress responses to endotracheal tube and Pro Seal Laryngeal Mask Airway?for laparoscopic gastric banding[J].Anesthesiology,2012,117(2):309-320
8 Joppich R,Richards P,Kelen R,et al.Analgesic efficacy and tolerability of intravenous morphine versus combined intravenous morphine and oxycodone in a 2-center,randomized,double-blind,pilot trial of patients with moderate to severe pain after total hip replacement[J].Clin Ther,2012,34(8):1751-1760
9 姜慧芳,连燕虹,周惠丹,等.羟考酮抑制单肺通气患者双腔支气管导管插管反应的适宜剂量[J].中华麻醉学杂志,2015,35(9):1104-1106
10 Bluth T,Pelosi P,de Abreu MG.The obese patient undergoing nonbariatric surgery[J].Curr Opin Anaesthesiol,2016,29(3):421-429
11 钱祖超,张群,罗华梁.盐酸羟考酮用于腹腔镜直肠癌根治术患者镇痛效果的观察[J].中国临床药理学与治疗学,2015,20(5):587-590
12 Kim NS,Lee JS,Park SY,et al.Oxycodone versus fentanyl for intravenous patient-controlled analgesia after laparoscopic supracervical hysterectomy:A prospective,randomized,double-blind study[J].Medicine(Baltimore),2017,96(10):e6286