羟考酮有效抑制妇科腔镜手术病人术后拔管时的呛咳反应  

Oxycodone can effectively inhibit the cough response of patient undergoing extubation after gynecological endoscopic surgery

作　　者：张庆伟[1] 董洪权[1] 金文杰[1] 钱燕宁[1] 董世阳[1] ZHANG Qingwei;DONG Hongquan;JIN Wenjie;QIAN Yanning;DONG Shiyang(Department of Anesthesiology,The First Affiliated Hospital of Nanjing Medical University,Nanjing,Jiangsu 210029,China)

机构地区：[1]南京医科大学第一附属医院麻醉科,江苏南京210029

出　　处：《安徽医药》2021年第1期136-139,共4页Anhui Medical and Pharmaceutical Journal

基　　金：国家自然科学基金青年科学基金项目(81701375)。

摘　　要：目的观察羟考酮能否有效抑制妇科腔镜手术病人全麻术后拔管时的呛咳反应。方法选择2018年7月至2019年8月在南京医科大学第一附属医院于气管插管全麻下行择期妇科腔镜手术的病人120例,ASA分级Ⅰ~Ⅱ级,年龄范围为18~65岁,采用随机数字表法分为羟考酮组(0.1 mg/kg)和对照组(等量0.9%氯化钠溶液),每组60例。两组病人分别于手术结束前10 min静脉注射羟考酮0.1 mg/kg或等量0.9%氯化钠溶液。记录两组病人入恢复室时(T1)、拔管时(T2)以及拔管后3 min(T3)的血流动力学变化、拔管时间、拔管期间咳嗽的发生例数和咳嗽严重程度;拔管期间气道不良反应例数以及拔管后5 min和30 min时的视觉模拟评分法(VAS)评分;记录术后需追加镇痛药、术后不良反应的例数及拔管后30 min改良Aldrete评分。结果羟考酮组与对照组相比,在T1、T2、T3时间点血流动力学变化未见明显差异;拔管期间咳嗽的发生率及严重程度明显降低(咳嗽例数31/46例;重度咳嗽2/11例,P<0.05);拔管时间、拔管期间气道不良反应、拔管后药物副作用及拔管后30 min改良Aldrete评分未见明显差异;羟考酮组拔管后5 min、30 min时VAS评分均明显低于对照组[(2.1±1.2)比(4.2±1.3)分;(1.9±1.1)比(4.1±2.2)分,P<0.05]且需追加镇痛药例数少于对照组(0例/7例,P<0.05)。结论妇科腔镜手术结束前10 min静脉注射羟考酮0.1 mg/kg能明显减少拔管时的呛咳反应,减轻术后疼痛且不增加不良反应。Objective To observe whether oxycodone can effectively inhibit the cough response during extubation of patients undergoing gynecological laparoscopic surgery after general anesthesia.Methods A total of120 patients with ASA grade I~Ⅱ,aged 18~65 years,undergoing elective gynecological endoscopic surgery with general anesthesia in the First Affiliated Hospital Of Nanjing Medical University from July 2018 to August 2019 were randomly divided into oxycodone group(0.1 mg/kg)and control group(saline equivalent)with 60 cases in each group.Oxycodone 0.1 mg/kg or saline was injected intravenously 10 minutes before the end of operation in both groups.The hemodynamic changes were recorded at the time of entering the recovery room(T1),extubation(T2)and 3 minutes after extubation(T3).The time of extubation,the cases of cough during extubation,the severity of cough(mild 0~2 times,moderate 3~5 times,severe>5 times),the number of airway reactions adverse andadditional analgesics and adverse drug reactions during extubation,the Visual Analogue Scale(VAS)at 5 minutes and 30 minutes after extubation and modified Aldrete evaluation in 30 minutes after extubationwere compared between the two groups.Results There was no significant difference in hemodynamic changes at T1,T2 and T3 compared with the control group.the incidence and severity of cough during extubation in oxycodone group were significantly lower(incidence31 vs.46 cases;severity of cough2 vs.11 cases,P<0.05);the extubation time and side effects of drugs and modified Aldrete score in 30 minutes after extubation were not significantly different;VAS scores in oxycodone group at 5 minutes and 30 minutes after extubation were significantly lower than those in the control group(2.1±1.2 vs.4.2±1.3;1.9±1.1 vs.4.1±2.2,P<0.05),and the cases requiring additional analgesics was less than the control group(0 vs.7 cases,P<0.05).Conclusion Intravenous injection of oxycodone 0.1 mg/kg 10 minutes before the end of gynecological laparoscopic surgery can significantly reduce the cough r

关 键 词：麻醉 静脉 羟考酮 麻醉 吸入 内窥镜检查 妇科外科手术 咳嗽 气管插管拔除 疼痛 手术后 

分 类 号：R614[医药卫生—麻醉学]