羟考酮与芬太尼在腹腔镜卵巢囊肿剥除术加速康复外科麻醉方案中应用的比较  

Comparison of Oxycodone and Fentanyl Application in Enhanced Recovery after Surgery Anesthesia Protocol in Laparoscopic Ovarian Cyst Exfoliation

作　　者：魏晶晶[1] 肖玮[1] 王天龙[1] 阚敏慧[1] 张清泉[1] WEI Jingjing;XIAO Wei;WANG Tianlong;KAN Minhui;ZHANG Qingquan(Department of Anesthesiology,Xuanwu Hospital,Capital Medical University/Beijing Municipal Geriatric Medical Research Center,Beijing 100053,China)

机构地区：[1]首都医科大学宣武医院麻醉科、北京市老年病医疗研究中心,北京100053

出　　处：《医学综述》2022年第18期3695-3700,共6页Medical Recapitulate

基　　金：中国医师协会麻醉学医师分会青年麻醉医师科研基金(21900009)。

摘　　要：目的比较羟考酮与芬太尼在腹腔镜卵巢囊肿剥除术加速康复外科(ERAS)麻醉方案中应用对术后恢复的影响。方法选取2020年1月至2021年1月在首都医科大学宣武医院行择期腹腔镜卵巢囊肿剥除术的患者50例,采用随机数字表法分为芬太尼组与羟考酮组,每组25例。麻醉诱导:芬太尼组给予芬太尼1μg/kg,丙泊酚1.5~2 mg/kg,罗库溴铵0.6 mg/kg;羟考酮组给予羟考酮0.1 mg/kg,丙泊酚1.5~2 mg/kg,罗库溴铵0.6 mg/kg;待脑电双频指数降至60以下,肌松起效后置入气管导管。麻醉维持:两组丙泊酚与瑞芬太尼均采用靶控输注,术中使用血管活性药物维持血压、心率的波动于基础水平±20%。手术结束拔出气管导管后,返回麻醉恢复室。记录麻醉前、插管后、切皮时、手术开始15 min的生命体征变化,拔管后及术毕0.5、6、12、24 h的数字疼痛评分(NRS)和内脏痛评分,以及两组术后情况。结果平均动脉压(MAP)和心率时点间的主效应差异有统计学意义(P<0.01),组间的主效应差异无统计学意义(P>0.05),组间与时点间无交互作用(P>0.05);两组患者MAP在插管后、切皮时、手术开始15 min呈升高趋势,心率呈先升高后降低的趋势(P<0.01)。NRS评分和内脏痛评分时点间的主效应差异有统计学意义(P<0.01),两组间的主效应差异有统计学意义(P<0.01),组间和时点间无交互作用(P>0.05);羟考酮组术毕0.5、6、12、24 h的内脏痛评分均低于芬太尼组(P<0.05)。羟考酮组追加镇痛药、呼吸抑制的比例低于芬太尼组[12.00%(3/25)比36.00%(9/25)、4.00%(1/25)比24.00%(6/25)]P<0.05),血糖波动、C反应蛋白变化幅度小于芬太尼组[0.70(0.20,1.00)mmol/L比0.95(0.60,1.30)mmol/L、(2.3±1.6)mg/L比(3.6±2.6)mg/L](P<0.05)。结论在腹腔镜卵巢囊肿剥除术ERAS麻醉管理中应用羟考酮,可以降低术后疼痛、内脏痛及呼吸抑制发生率,更好地控制应激反应,适合短小手术的ERAS麻醉管理方案。Objective To compare the effects of oxycodone and fentanyl on postoperative recovery during enhanced recovery after surgery(ERAS)anesthesia protocol of laparoscopic ovarian cyst exfoliation.Methods Fifty patients undergoing elective laparoscopic ovarian cyst excision in Xuanwu Hospital,Capital Medical University from Jan.2020 to Jan.2021 were included and divided into a fentanyl group and an oxycodone group according to random number table method,with 25 patients in each group.Anesthesia induction:the fentanyl group was given fentanyl 1μg/kg,propofol 1.5-2 mg/kg,rocuronium 0.6 mg/kg;the oxycodone group was given oxycodone 0.1 mg/kg,propofol 1.5-2 mg/kg,rocuronium 0.6 mg/kg;tracheal catheter was inserted after the bispectral index dropped below 60 and muscle relaxation took effect.Anesthesia maintenance:both groups received target-controlled infusion of propofol and remifentanil,and vasoactive drugs were used to maintain the fluctuation of blood pressure and heart rate at the basal level of±20%.After the tracheal tube was removed,the patient was returned to the post anesthesia care unit.The changes of vital signs before anesthesia,after intubation,at the time of skin resection,15 min at the beginning of surgery,numeric rating scale(NRS)and visceral pain scores at 0.5,6,12 and 24 h after extubation,and postoperative conditions of the two groups were recorded.Results There was statistically significant difference in the main effect of mean arterial pressure(MAP)and heart rate between time points(P<0.01),but no significant difference in the main effect between groups(P>0.05),and no interaction between groups and time points(P>0.05).MAP of both groups showed an increasing trend after intubation,during skin resection and 15 min after surgery start,and heart rate showed a trend of first increasing and then decreasing(P<0.01).There were statistically significant differences in the main effect of NRS score and visceral pain score between time points(P<0.01),and also between the two groups(P<0.01),and no interaction betw

关 键 词：腹腔镜卵巢囊肿剥除术 羟考酮 加速康复外科 术后疼痛 

分 类 号：R614[医药卫生—麻醉学]