羟考酮超前镇痛方案对胸腔镜手术患者的临床效果及对围手术期炎性因子的影响  

The effect of oxycodone on postoperative preemptive analgesia and expression of inflammatory factors in patients undergoing thoracoscopic surgery

作　　者：商媛媛 乐婷[1] 肖娈 杨勇[1] 李平[2] SHANG Yuanyuan;LE Ting;XIAO Luan;YANG Yong;LI Ping(Department of Anesthesiology,General Hospital of North China Petroleum Administration Bureau,Renqiu Hebei 062552,China)

机构地区：[1]华北石油管理局总医院麻醉科,河北任丘062552 [2]华北石油管理局总医院二部医院耳鼻喉科,河北任丘062552

出　　处：《中国急救复苏与灾害医学杂志》2023年第9期1199-1202,共4页China Journal of Emergency Resuscitation and Disaster Medicine

基　　金：河北省卫生健康委员会医学会科技计划项目(编号:20221556)。

摘　　要：目的探究羟考酮对胸腔镜手术患者超前镇痛(PA)的效果及对炎性反应的影响。方法纳入2021年6月—2022年1月在华北石油管理局总医院接受胸腔镜手术的患者100例,随机分为超前镇痛组50例和对照组50例。术后两组患者均给予帕瑞昔布钠40 mg静脉注射,然后超前镇痛组给予羟考酮0.1 mg/kg静脉注射,对照组给予舒芬太尼0.1μg/kg静脉注射。观察两组患者手术结束时(T1)及手术结束后1 h(T2)、6 h(T3)和24 h(T4)的血清IL-6和IL-10水平,静态疼痛评分(NRS)、Ramsay镇静评分、镇痛相关不良反应、肺部炎症事件和术后住院时间,并比较两组患者上述指标的差异。结果术后T3和T4超前镇痛组的IL-6水平显著低于对照组,IL-10水平显著高于对照组(P<0.05);在各观察时间点,超前镇痛组内脏痛的NRS均显著低于对照组,Ramsay镇静评分比较无统计学意义(P>0.05),拔管后6 h、24 h和48 h切口痛的NRS均显著低于对照组(P<0.05);在术后恶心呕吐及肺部炎症发生率上,超前镇痛组显著低于对照组(P<0.05)。结论在胸腔镜手术患者中超前镇痛应用羟考酮可调节炎症细胞因子水平,降低炎性反应,减少术后并发症。Objective To observe the effect of oxycodone on postoperative preemptive analgesia in patients undergoing thoracoscopic surgery and its effect on inflammatory response.Methods 100 patients who underwent thoracoscopic surgery were randomly divided into observation group and control group in the General Hospital of North China Petroleum Administration from June 2021 to January 2022.After operation,all patients in the two groups were given parecoxib sodium 40 mg intravenously,then oxycodone 0.1 mg/kg intravenously in the observation group and sufentanil 0.1μg/kg intravenously in the control group.The levels of serum IL-6 and IL-10,numerical rating scale(NRS),Ramsay Sedation score,analgesic related adverse reactions,pulmonary inflammatory events and postoperative hospital stay were recorded at the end of operation(T1),1 hours(T2),6 hours(T3)and 24 hours(T4),and the differences of the above indexes were compared between the 2 groups.Results At 6 hours and 24 hours after thoracoscopic surgery,the IL-6 level in the observation group was less than that in the control group,and the IL-10 level in the observation group was larger than that in the control group(P<0.05).The incidence of postoperative nausea,vomiting and pulmonary inflammation in the observation group was less than that in the control group(P<0.05).At each time point,the NRS of visceral pain in the experimental group was less than that in the control group,and there was no significant difference in Ramsay Sedation score(P>0.05).The NRS of incision pain at 6 hours,24 hours and 48 hours after extubation was less than that in the control group(P<0.05).Conclusion In patients undergoing thoracoscopic surgery,preemptive analgesia with oxycodone can regulate the level of inflammatory cytokines,reduce inflammatory reaction and reduce complications.

关 键 词：羟考酮 超前镇痛 胸腔镜手术 

分 类 号：R657.3[医药卫生—外科学]