舒芬太尼与羟考酮在胰管结石老年患者体外冲击波碎石术中的镇痛效果  

Analgesic effect of sufentanil and oxycodone in extracorporeal shock wave lithotripsy of elderly patients with pancreatic duct stones

作　　者：施海滨 杨晶[2] 孙建良 赵莉 周大春[3] SHI Hai-bin;YANG Jing;SUN Jian-liang;ZHAO Li;ZHOU Da-chun(Department of Anesthesiology,Affiliated Hangzhou First People’s Hospital,Zhejiang University School of Medicine,Hangzhou ZHEJIANG 310006,China;Department of Gastroenterology,Affiliated Hangzhou First People’s Hospital,Zhejiang University School of Medicine,Hangzhou ZHEJIANG 310006,China;Department of Anesthesiology,Sir Run Run Shaw Hospital Affiliated to Zhejiang University,Hangzhou ZHEJIANG 310016,China)

机构地区：[1]浙江大学医学院附属杭州市第一人民医院麻醉科,浙江杭州310006 [2]浙江大学医学院附属杭州市第一人民医院消化科,浙江杭州310006 [3]浙江大学医学院附属邵逸夫医院麻醉科,浙江杭州310016

出　　处：《中国新药与临床杂志》2021年第10期704-708,共5页Chinese Journal of New Drugs and Clinical Remedies

基　　金：中华医学会消化内镜学分会麻醉协作组人福科研基金(CSDE012017120005);浙江省医药卫生科技计划项目(2020KY697);浙江省医药卫生科技计划项目(2018RC013)。

摘　　要：目的比较舒芬太尼或羟考酮联合丙泊酚靶控输注对胰管结石老年患者体外冲击波碎石术(ESWL)中的镇痛效果和安全性。方法选择拟行ESWL术老年胰管结石患者60例,随机分为2组,每组30例。术前5 min羟考酮组给予羟考酮0.15 mg·kg^(-1),舒芬太尼组给予舒芬太尼0.15μg·kg^(-1),均缓慢静脉推注。2组均行丙泊酚静脉靶控输注,起始血浆靶浓度2.0μg·mL^(-1),术中维持脑电双频谱指数(BIS)目标值60±5。记录2组丙泊酚用量、围术期生命体征指标、苏醒时间,评估术后1 h疼痛视觉模拟量表(VAS)评分,观察术中和术后不良反应发生情况。结果与舒芬太尼组比较,羟考酮组丙泊酚用量增加[(233.7±31.0)mg vs.(275.7±41.6)mg,P<0.05],苏醒时间延长[(8.8±2.7)min vs.(10.7±2.8)min,P<0.05]。与入手术室(T_(0))时比较,2组ESWL开始后30 min(T_(2))、手术结束(T_(3))和清醒(T_(4))时心率均升高,且T_(2)时舒芬太尼组高于羟考酮组(P<0.05);与T_(0)时比较,2组ESWL开始(T_(1))时平均动脉压(MAP)均下降,羟考酮组T_(4)时MAP下降(P<0.05),但各观察时点组间比较均无显著差异(P>0.05)。术中和术后不良反应发生率及术后1 h VAS评分组间比较,差异均无显著意义(P>0.05)。结论在BIS监测下,小剂量舒芬太尼或羟考酮联合丙泊酚靶控输注均能满足胰管结石老年患者ESWL镇痛、镇静的需求,联合舒芬太尼时丙泊酚用量更少,且患者苏醒迅速。AIM To compare the analgesic effect and safety of sufentanil or oxycodone combined with propofol target-controlled infusion in extracorporeal shock wave lithotripsy(ESWL)of elderly patients with pancreatic duct stones.METHODS Sixty elderly patients with pancreatic duct stones who planned to undergo ESWL were randomly divided into 2 groups,30 cases in each group.Five minutes before the operation,the oxycodone group was given oxycodone 0.15 mg·kg^(-1),and the sufentanil group was given sufentanil 0.15μg·kg^(-1),both of which were intravenously injected slowly.Both groups underwent intravenous target-controlled infusion of propofol.The initial plasma target concentration was 2.0μg·mL^(-1),and the target value of the bispectral index(BIS)of 60±5 was maintained during the operation.The dosage of propofol,perioperative vital signs,and recovery time were recorded in the two groups,the visual analog scale(VAS)scores of 1 h postoperative pain were evaluated,and the occurrence of intraoperative and postoperative adverse reactions was observed.RESULTS Compared with the sufentanil group,the dose of propofol in the oxycodone group increased((233.7±31.0)mg vs.(275.7±41.6)mg,P<0.05),and the recovery time was prolonged((8.8±2.7)min vs.(10.7±2.8)min,P<0.05).The heart rate(HR)of each group increased at 30 minutes after the beginning of ESWL(T_(2)),the end of the operation(T_(3)),and the awake(T_(4))compared to when entering the operating room(T_(0)).At T_(2),the HR of the sufentanil group was higher than that of oxycodone group(P<0.05).Compared with T_(0),mean arterial pressure(MAP)decreased at the beginning of ESWL(T_(1))in the two groups,and MAP decreased at T_(4)in the oxycodone group(P<0.05),but there was no significant difference between the groups at each observation time point(P>0.05).There was no significant difference in the incidence of adverse reactions during and after operation and the VAS score at 1 h after operation(P>0.05).CONCLUSION Under BIS monitoring,low-dose sufentanil or oxycodone combined with prop

关 键 词：羟考酮 舒芬太尼 丙泊酚 老年人 体外冲击波碎石术 

分 类 号：R971[医药卫生—药品]