羟考酮联合丙泊酚用于乳腺癌保乳手术静脉全麻的临床效果评估  

Evaluation of clinical effects of combine use of oxycodone and propofol for total intravenous anesthesia in breast⁃conserving surgery for breast cancer

作　　者：王玉东 刘育贤 卞清明 刘辉[1,2] WANG Yudong;LIU Yuxian;BIAN Qingming;LIU Hui(School of Anesthesiology,Xuzhou Medical University,Xuzhou 221002;Department of Anesthesiology,Jiangsu Cancer Hospital,the Affiliated Cancer Hospital of Nanjing Medical University,Nanjing 210009,China)

机构地区：[1]徐州医科大学麻醉学院,江苏徐州221004 [2]江苏省肿瘤医院,江苏省肿瘤防治研究所,南京医科大学附属肿瘤医院麻醉科,江苏南京210009

出　　处：《南京医科大学学报（自然科学版）》2023年第12期1724-1728,共5页Journal of Nanjing Medical University(Natural Sciences)

基　　金：江苏省卫生健康委干部保健科研项目(BJ20028)。

摘　　要：目的:评估羟考酮联合丙泊酚用于全凭静脉麻醉对乳腺癌保乳手术患者术中全麻效果、围手术期不良反应和镇痛效果的影响。方法:选择美国麻醉医师协会(American Society of Anesthesiologists,ASA)评分Ⅰ或Ⅱ级,年龄26~61岁,体重指数19~28 kg/m^(2),择期行乳腺癌保乳手术的患者80例,随机分为芬太尼组和羟考酮组,每组40例。记录两组患者麻醉诱导前(T_(0))、气管插管前即刻(T_(1))、手术开始时(T_(2))、切除乳腺标本时(T_(3))、手术结束时(T_(4))的收缩压、舒张压、心率;术后2 h、6 h、24 h、48 h静息状态及运动时的疼痛数字评分(numerical rating scale,NRS);患者清醒时间、拔管时间、丙泊酚用量;观察两组患者诱导期咳嗽反射、术中知晓、术中低血压、术后躁动、恶心呕吐、皮肤瘙痒等不良反应的发生率。结果:T_(2)、T_(3)时羟考酮组收缩压、舒张压、心率均显著高于芬太尼组(P<0.05)。羟考酮组患者术后2 h静息及运动时疼痛NRS评分均低于芬太尼组(P<0.05)。羟考酮组诱导期咳嗽反射的发生率显著低于芬太尼组(P<0.05)。结论:羟考酮联合丙泊酚全凭静脉麻醉可安全用于乳腺癌保乳手术,全麻诱导以及维持期间麻醉效果满意,术中对循环影响小,术后镇痛效果确切。Objective:To evaluate the effects of combined use of oxycodone and propofol for total intravenous anesthesia in patients with breast cancer undergoing breast⁃conserving surgery,on the intraoperative anesthesia,perioperative adverse reactions and analgesic effects.Methods:Eighty patients elective undergoing breast⁃conserving surgery for breast cancer,with American Society of Anesthesiologists(ASA)physical status classificationⅠorⅡ,aged 26⁃61 year,and body mass index(BMI)of 19~28 kg/m^(2),were randomly divided into oxycodone group(n=40)and fentanyl group(n=40).The systolic blood pressure(SBP),diastolic blood pressure(DBP),and heart rate(HR)were recorded at the following time points:before anesthesia induction(T_(0)),immediately before tracheal intubation(T_(1)),at the start of surgery(T_(2)),during resection of the breast specimen(T_(3)),and at the end of surgery(T_(4)).The numerical rating scale(NRS)for pain were recorded at rest and during movement at 2 h,6 h,24 h and 48 h after surgery.The time to awakening,extubation time,and propofol consumption were also recorded.The incidence of cough reflex during induction,intraoperative awareness,intraoperative hypotension,postoperative agitation,nausea and vomiting,and skin itching were observed in both groups.Results:At T_(2)and T_(3),the SBP,DBP and HR in the oxycodone group were significantly higher than those in the fentanyl group(P<0.05).The NRS scores for resting pain and movement pain at 2 h after surgery were significantly lower in the oxycodone group than the fentanyl group(P<0.05).The incidence of cough reflex during induction was significantly lower in the oxycodone group than in the fentanyl group(P<0.05).Conclusion:Oxycodone combined with propofol for total intravenous anesthesia can be safely used in breast⁃conserving surgery for breast cancer.It provides satisfactory anesthesia induction and maintenance,has minimal impact on circulation during surgery,and has effective postoperative analgesic effects.

关 键 词：羟考酮 丙泊酚 芬太尼 全凭静脉麻醉 乳腺癌 保乳手术 

分 类 号：R614.2[医药卫生—麻醉学]