羟考酮对结直肠癌老年患者围术期疼痛及认知功能等的影响  

Effects of oxycodone on perioperative pain and cognitive function in elderly patients with colorectal cancer

作　　者：王舒 王俊博 张娇娇 关明函 陈思 薛志强 Wang Shu;Wang Junbo;Zhang Jiaojiao;Guan Minghan;Chen Si;Xue Zhiqiang(Department of Anesthesiology,Benxi Central Hospital,Benxi 117000,China)

机构地区：[1]本溪市中心医院麻醉科,本溪117000

出　　处：《肿瘤研究与临床》2025年第1期45-49,共5页Cancer Research and Clinic

基　　金：白求恩公益基金会资助项目(ezmr2022-040)。

摘　　要：目的探讨腹腔镜手术麻醉中应用羟考酮对结直肠癌老年患者围术期疼痛及认知功能等的影响。方法前瞻性随机对照试验。选取本溪市中心医院2022年6月年2023年12月择期行腹腔镜手术的结直肠癌老年患者88例,采用随机数字表法分为试验组(44例)和对照组(44例)。试验组麻醉诱导予以羟考酮0.2~0.3 mg/kg,术中维持羟考酮0.1~0.15 mg·kg-1·h-1,术后镇痛泵静脉注入羟考酮;对照组麻醉诱导予以舒芬太尼0.2~0.3μg/kg,术中维持瑞芬太尼0.1~0.3μg·kg-1·min-1,术后镇痛泵静脉注入舒芬太尼。比较两组麻醉诱导前(T0)、气管插管时(T1)、切皮时(T2)、拔管时(T3)的血压和心率,术后30 min、6 h、24 h、48 h疼痛数字评定量表(NRS)评分,术后1、3、7 d意识模糊评估法(CAM)评估结果及简易智能量表(MMSE)评分评估术后早期认知功能下降等不良反应发生情况。结果最终有81例纳入研究,其中试验组41例,包括男性20例,女性21例,年龄(76±3)岁;对照组40例,包括男性19例,女性21例,年龄(75±2)岁。两组间性别构成、年龄、体质量指数、手术时间、术中出血量差异均无统计学意义(均P>0.05)。试验组T0、T2及T3时血压[(91±8)mmHg(1 mmHg=0.133 kPa)比(89±10)mmHg、(92±9)mmHg比(90±8)mmHg、(93±9)mmHg比(92±9)mmHg]和心率[(70±15)次/min比(69±16)次/min、(68±12)次/min比(67±12)次/min、(70±15)次/min比(69±14)次/min]与对照组比较,差异均无统计学意义(均P>0.05);试验组T1时血压和心率[(101±9)mmHg,(83±15)次/min]均高于对照组[(93±11)mmHg,(70±17)次/min],差异均有统计学意义(t值分别为3.73、3.77,均P<0.001)。试验组与对照组患者术后30 min[(2.6±1.2)分比(2.8±1.1)分]、6 h[(2.8±1.6)分比(2.9±1.3)分]、24 h[(1.8±1.2)分比(2.1±1.3)分],48 h[(1.5±0.7)分比(1.5±0.7)分]NRS评分比较,差异均无统计学意义(均P>0.05)。试验组术后早期认知功能下降[4.9%(2/41)比22.5%(9/40)]、术后恶心呕吐[7.3%(3/41)比25.0%ObjectiveTo investigate the effects of oxycodone on perioperative pain and cognitive function in elderly patients with colorectal cancer.MethodsA prospective randomized-controlled trial was conducted.A total of 88 elderly patients with colorectal cancer who underwent elective laparoscopic surgery at Benxi Central Hospital from June 2022 to December 2023 were selected.According to random number table method,all patients were randomly divided to the experimental group and the control group,with 44 cases in each group.Anesthesia in the experimental group was induced with oxycodone 0.2-0.3 mg/kg,intraoperative oxycodone was maintained at 0.1-0.15 mg·kg-1·h-1;oxycodone was intravenously injected with analgesia pump after surgery.In the control group,anesthesia was induced with sufentanil 0.2-0.3μg/kg,remifentanil was intraoperatively maintained at 0.1-0.3μg·kg-1·min-1,sufentanil was intravenously injected with analgesia pump after surgery.Blood pressure and heart rate before anesthesia induction(T 0),at tracheal intubation(T 1),at skin incision(T 2),and at extubation(T 3)of both groups were compared;numerical rating scale(NRS)at 30 minutes,6 h,24 h,and 48 h after surgery were scored,the confusion assessment method(CAM)and the mini-mental state examination(MMSE)score at day 1,3,7 after surgery were used to assess the postoperative early cognitive decline and other adverse reactions.ResultsFinally,81 patients were included in the study.There were 41 cases in the experimental group including 20 males and 21 females with the age of(76±3)years,and 40 cases in the control group including 19 males and 21 females with the age of(75±2)years.There were no statistically significant differences in gender composition,age,body mass index,operative time,intraoperative blood loss(all P>0.05).There were statistically differences in blood pressure[(91±8)mmHg(1 mmHg=0.133 kPa)vs.(89±10)mmHg at T 0,(92±9)mmHg vs.(90±8)mmHg at T 2,(93±9)mmHg vs.(92±9)mmHg at T 3]and heart rate[(70±15)times/min vs.(69±16)times/min at T 0,(6

关 键 词：结直肠肿瘤 羟考酮 认知功能 镇痛 

分 类 号：R735.34[医药卫生—肿瘤]