单次静注盐酸羟考酮对腹腔镜下行直肠肿物切除术后急性疼痛的影响

发布时间：2018-05-27 14:07

  本文选题：羟考酮 + 芬太尼　； 参考：《吉林大学》2015年硕士论文

【摘要】：目的：比较单次静脉注射盐酸羟考酮与芬太尼对腹腔镜下行直肠肿物切除术患者术后急性疼痛及苏醒质量的影响。 方法：选择择期全身麻醉下行腹腔镜直肠肿物切除术（不保肛）患者59例，ASA I-II级，男26例，女33例，年龄40-76岁。采用随机数字表法，将其分为2组：盐酸羟考酮注射液组（O组n=30）和芬太尼注射液组（F组n=29）。芬太尼组一名患者Prince-Henry评分达4分，追加镇痛药，提前退出试验。手术结束时给与羟考酮0.1mg/kg（生理盐水稀释为1mg/ml）或芬太尼1ug/kg（生理盐水稀释为10ug/ml）。当患者恢复自主呼吸后，每分钟呼唤患者一次，待患者意识清晰，反射活动恢复后拔除气管导管，拔管后吸入空气，当SpO2＜90%时，面罩吸氧（50%）并记录。拔管后20min各组患者接镇痛泵行PCIA。拔管即刻及拔管后5min，10min，15min及20min各时间点分别评定OAA/S镇静分级及术后疼痛Prince-Henry评分。当OAA/S镇静分级为0级或Prince-Henry评分达4分时，病例剔除，不参与结果评定。记录患者麻醉时间、手术时间、自主呼吸恢复时间、拔管时间和苏醒时间(停药到正确回答简单问题)，记录术毕即刻、拔管即刻及拔管后5min，10min，15min及20min的心率、SpO2和平均动脉压及各时间点评定的OAA/S镇静分级及术后疼痛Prince-Henry评分。 结果：两组患者性别、年龄、体重及BMI、麻醉时间及手术时间比较，，差异无统计学意义。羟考酮组自主呼吸恢复时间、拔管时间及苏醒时间均较芬太尼组短，差异有统计学意义(p＜0.05)。重复测量方差分析显示：术毕即刻到拔管后20分钟期间，羟考酮组心率，平均动脉压变化趋势与芬太尼组一致。两组术后急性疼痛均有缓解，但各时间点芬太尼组Prince-Henry镇痛评分均高于羟考酮组，且术后急性疼痛发生例数较羟考酮组多（7:2）；OAA/S镇静分级均低于羟考酮组，术后镇静过度例数亦较羟考酮组多（9:1）；血氧饱和度下降幅度较羟考酮组大，SpO2≤90%发生例数较羟考酮组多（5:1），面罩吸氧后均改善。恶心及呕吐等副作用的发生率两组相似，无统计学差异。 结论：手术结束时单次静脉注射羟考酮0.1mg/kg比静脉注射芬太尼1ug/kg能更好的预防腹腔镜下行直肠肿物切除术患者术后急性疼痛的发生，且镇静及呼吸抑制等副作用更小，全麻苏醒期应用更安全。
[Abstract]:Aim: to compare the effects of single intravenous administration of hydroxone hydrochloride and fentanyl on postoperative acute pain and recovery quality in patients undergoing laparoscopic rectal tumor resection. Methods: a total of 59 patients (26 males and 33 females, aged 40-76 years) with ASA grade I-II were selected for laparoscopic rectal mass resection under elective general anesthesia. The rats were randomly divided into two groups: hydroxy coxone hydrochloride injection group (n = 30) and fentanyl injection group (n = 29). One patient in fentanyl group had a Prince-Henry score of 4, added analgesics and quit the trial ahead of time. At the end of the operation, they were given 0.1 mg / kg of hydroxycodone (diluted to 1 mg / ml of saline) or 1 mg / kg of fentanyl (diluted to 10 mg / ml of saline). When the patient returned to spontaneous breathing, he called to the patient once a minute. When the patient's consciousness was clear, the reflex activity was recovered, the trachea catheter was removed, and the air was inhaled after the extubation. When SpO2 < 90, the mask inhaled oxygen 50% and recorded. After extubation, the patients in 20min group were treated with analgesic pump. OAA/S sedation grade and postoperative pain Prince-Henry score were evaluated immediately after extubation, 10 min after extubation and 15 minutes after extubation and at each time point of 20min. When the OAA/S sedation grade was 0 or the Prince-Henry score was 4, the cases were eliminated and the results were not evaluated. Time of anesthesia, operation, recovery of spontaneous respiration, extubation and recovery were recorded. Heart rate SpO2, mean arterial pressure, OAA/S sedation grade and postoperative pain Prince-Henry score were evaluated immediately and 5 min after extubation and 20min. Results: there was no significant difference in sex, age, body weight, BMI, anesthesia time and operation time between the two groups. The time of spontaneous respiration recovery, extubation and recovery in hydroxycodone group was shorter than that in fentanyl group (P < 0.05). Repeated analysis of variance showed that the change trend of heart rate and mean arterial pressure in hydroxycodone group was the same as that in fentanyl group between immediately after operation and 20 minutes after extubation. The Prince-Henry analgesia score of fentanyl group was higher than that of hydroxycodone group at each time point, and the incidence of postoperative acute pain was higher than that of hydroxycodone group, and the sedation grade of acute pain was lower than that of hydroxycodone group, and the sedation score of fentanyl group was lower than that of hydroxycodone group. The number of cases of hypersedation after operation was 9: 1, the decrease of blood oxygen saturation was more than that of hydroxone group, the incidence of SPO 2 鈮

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