盐酸羟考酮注射液用于胃癌根治术超前镇痛的临床疗效及对患者应激反应的影响  

Clinical efficacy of oxycodone hydrochloride injection for preemptive analgesia in radical gastrectomy and its effect on stress response of patients

作　　者：蔡昀方[1] 王理仁[1] 张润泽[1] 张雯[1] 崔小英[1] 方军[1] CAI Yun-fang;WANG Li-ren;ZHANG Run-ze(Department of Anesthesiology,Zhejiang Cancer Hospital,Hangzhou,Zhejiang 310022,China)

机构地区：[1]浙江省肿瘤医院麻醉科

出　　处：《中华全科医学》2019年第11期1821-1824,1863,共5页Chinese Journal of General Practice

基　　金：浙江省医药卫生科技计划项目(2018KY025)

摘　　要：目的观察应用盐酸羟考酮超前镇痛对胃癌根治术患者进行围术期疼痛管理的临床疗效。方法以2017年3月-2019年3月于浙江省肿瘤医院进行胃癌根治术的130例患者为研究对象,按随机数字表法分为研究组和对照组,各65例。所有患者均进行全身麻醉条件下的胃癌根治术,研究组切皮前30 min予以盐酸羟考酮超前镇痛,对照组予以地佐辛超前镇痛。统计不同麻醉时点HR、MAP和SpO2等血流动力学参数,检测不同时点血清应激反应因子水平,比较术后不同时点VAS评分差异,记录术后自控镇痛药物用量、苏醒时间和拔管时间,观察不良反应情况。结果研究组与对照组T0~T4时点HR、MAP和SpO2差异均无统计学意义(均P>0.05);研究组患者术后6 h、12 h、24 h和36 h静息VAS评分和咳嗽VAS评分均低于对照组(均P<0.001);研究组手术结束即刻至术后24 h血清E、NE和Cor含量水平均低于对照组(均P<0.001);研究组术后自控镇痛舒芬太尼用量[(52.28±8.61)μg]低于对照组[(74.37±12.49)μg],P<0.001;研究组不良反应总体发生率(7.69%)低于对照组(23.08%,χ^2=5.909,P=0.015)。结论盐酸羟考酮用于胃癌根治术超前镇痛,可有效维持患者麻醉过程中血流动力学稳定,抑制术后应激反应,缓解疼痛反应强度,减少术后镇痛药物用量,降低不良反应发生率。Objective To observe the clinical effect of preemptive analgesia with oxycodone hydrochloride on perioperative pain management in patients undergoing radical gastrectomy. Methods A total of 130 patients with gastric cancer underwent radical gastrectomy in Zhejiang Cancer Hospital from March 2017 to March 2019 were selected and divided into study group(n=65) and control group(n=65) according to random number table method. All patients underwent radical gastrectomy under general anesthesia. Oxycodone hydrochloride preemptive analgesia was given in the study group 30 minutes before skin incision, while dezocine preemptive analgesia was given in the control group. The hemodynamic parameters such as HR, MAP and SpO2 were measured at different anesthesia time points. The levels of serum stress response factors were detected, and the VAS scores were compared. The dosage of self-controlled analgesics, recovery time and extubation time were recorded, and the adverse reactions were observed. Results There was no significant difference in HR, MAP and SpO2 between the study group and the control group at T0-T4(all P>0.05). The resting VAS scores and cough VAS scores of the study group were lower than those of the control group at 6, 12, 24 and 36 hours after operation(all P<0.001). The serum E, NE and Cor levels of the study group were lower than those of the control group at 24 hours after operation(all P<0.001). The dosage of sufentanil for patient-controlled analgesia after operation in the study group(52.28± 8.61) μg was less than that in the control group(74.37±12.49) μg (P<0.001). The overall incidence of adverse reactions in the study group(7.69%) was lower than that in the control group(23.08%, χ^2=5.909, P=0.015). Conclusion Oxycodone hydrochloride for preemptive analgesia in radical gastrectomy can effectively maintain hemodynamic stability during anesthesia, inhibit post-operative stress response, relieve pain response intensity, reduce the dosage of analgesics, and reduce the incidence of adverse reactions r

关 键 词：盐酸羟考酮 胃癌根治术 超前镇痛 应激反应 临床疗效 

分 类 号：R614.2[医药卫生—麻醉学]