盐酸羟考酮复合丙泊酚对内镜黏膜下剥离术麻醉效果研究
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摘要
目的探讨盐酸羟考酮注射液复合丙泊酚实施内镜黏膜下剥离术(ESD)的麻醉效果及安全性。方法选取2015年1—6月在北部战区空军医院行ESD术的患者60例为研究对象。采用随机数字表法将患者分为3组,分别为单纯丙泊酚组(P组)、芬太尼+丙泊酚组(F组)及羟考酮注射液+丙泊酚组(O组)。记录各组入室(T_0)、诱导完成(T_1)、内镜进入食管入口(T_2)、内镜粘膜下剥离时(T_3)及术毕苏醒后15 min(T_4)的收缩压(SBP)、舒张压(DBP)、心率(HR)、血氧饱和度(Sp O2);观察手术过程中体动发生情况和术后胃痉挛痛分级;同时记录各组患者丙泊酚用量、麻醉恢复时间及并发症发生情况。结果 T_1～T_4时间点F组和O组患者的SBP、DBP、HR均高于P组对应时间点(P <0. 05)。F组和O组患者术中Ⅱ级、Ⅲ级体动发生率及术后2级、3级胃痉挛痛发生率均明显低于P组(P <0. 05)。F组和O组术中丙泊酚用量均低于P组(P <0. 05)。F组和O组丙泊酚注射痛、咽部不适、低血压发生率均低于P组(P <0. 05); O组患者术中呛咳反应、低氧血症和术后恶心呕吐发生率明显低于F组(P <0. 05)。结论盐酸羟考酮注射液辅助丙泊酚应用于ESD麻醉,患者呼吸循环平稳,可明显减少丙泊酚用量,加强术中镇痛效果,不良反应少。
Objective To investigate the anesthetic effect and safety of oxycodone injection combined with propofol for endoscopic submucosal dissection( ESD). Methods A retrospective study was performed on 60 cases of patients who underwent ESD surgery from January to June 2015. Patients were randomly divided into the 3 groups: propofol group( P group),fentanyl + propofol group( F group) and oxycodone + propofol group( O group),with 20 cases in each group. Systolic blood pressure( SBP),diastolic blood pressure( DBP),heart rate( HR) and blood oxygen saturation( Sp O2) were recorded at the time of admission( T_0),induction completion( T_1),endoscopic entry into the esophagus( T_2),endoscopic submucosal dissection( T_3) and 15 minutes postoperative recovery( T_4). The incidence of body movement and the grade of postoperative gastric spasm pain were observed. The dosage of propofol,anesthesia recovery time and complications of each group were also recorded. Results At T_1-T_4 time points,SBP,DBP and HR of F group and O group were all higher than those of P group( P < 0. 05). The F group and O group of patients whose body moving rate was II and III,and the postoperative gastric spasm pain in Grade 2 and Grade 3 were all significantly lower than those in the P group( P < 0. 05).The intraoperative propofol dosage in F group and O group was lower than that in P group( P < 0. 05). The incidence of propofol injection pain,pharyngeal discomfort and hypotension in F group and O group were lower than those in P group( P < 0. 05). The incidence of intraoperative cough reaction,hypoxemia and postoperative nausea and vomiting in O group was significantly lower than that in F group( P < 0. 05). Conclusion Oxycodone hydrochloride injection combined with propofol used in endoscopic submucosal dissection,could stable respiration and circulation,significantly reduce propofol dosage,strengthen the analgesia effect,and reduce complications.
Objective To investigate the anesthetic effect and safety of oxycodone injection combined with propofol for endoscopic submucosal dissection( ESD). Methods A retrospective study was performed on 60 cases of patients who underwent ESD surgery from January to June 2015. Patients were randomly divided into the 3 groups: propofol group( P group),fentanyl + propofol group( F group) and oxycodone + propofol group( O group),with 20 cases in each group. Systolic blood pressure( SBP),diastolic blood pressure( DBP),heart rate( HR) and blood oxygen saturation( Sp O2) were recorded at the time of admission( T_0),induction completion( T_1),endoscopic entry into the esophagus( T_2),endoscopic submucosal dissection( T_3) and 15 minutes postoperative recovery( T_4). The incidence of body movement and the grade of postoperative gastric spasm pain were observed. The dosage of propofol,anesthesia recovery time and complications of each group were also recorded. Results At T_1-T_4 time points,SBP,DBP and HR of F group and O group were all higher than those of P group( P < 0. 05). The F group and O group of patients whose body moving rate was II and III,and the postoperative gastric spasm pain in Grade 2 and Grade 3 were all significantly lower than those in the P group( P < 0. 05).The intraoperative propofol dosage in F group and O group was lower than that in P group( P < 0. 05). The incidence of propofol injection pain,pharyngeal discomfort and hypotension in F group and O group were lower than those in P group( P < 0. 05). The incidence of intraoperative cough reaction,hypoxemia and postoperative nausea and vomiting in O group was significantly lower than that in F group( P < 0. 05). Conclusion Oxycodone hydrochloride injection combined with propofol used in endoscopic submucosal dissection,could stable respiration and circulation,significantly reduce propofol dosage,strengthen the analgesia effect,and reduce complications.
引文
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[9]王志华,陈勇,欧阳碧山,等.复合羟考酮时丙泊酚抑制无痛胃镜患者体动反应的ED50/ED95[J].海南医学,2017,28(10):1593-1595.
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[11]张杜枭,葛卫红,于锋,等.羟考酮临床治疗研究进展[J].药学与临床研究,2014,22(6):527-531.
[2]王保健,顾文芬,胡忠卓,等.内镜下黏膜切除术与内镜黏膜下剥离术治疗消化道神经内分泌肿瘤的对比研究[J].中国内镜杂志,2017,23(9):75-78.
[3]Nielsen CK,Ross FB,Lotfipour S,et al. Oxycodone and morphine have distinctly different pharmacological profiles:radioligand binding and behavioural studies in two rat models of neuropathic pain[J]. Pain,2007,132(3):289-300.
[4]徐钢,陆颖,黄礼兵,等.右美托咪啶复合丙泊酚在无痛ESD中的应用[J].实用药物与临床,2011,14(6):470-471.
[5]李聪,申艳.不同剂量地佐辛联合丙泊酚用于无痛胃镜的临床观察[J].中国药物与临床,2014,14(2):267-268.
[6]徐建国.盐酸羟考酮的药理学和临床应用[J].临床麻醉学杂志,2014,30(5):511-513.
[7]Andreassen TN,Klepstad P,Davies A,et al. Is oxycodone efficacy reflected in serum concentrations? A multicenter,cross-sectional study in 456 adult cancer patients[J]. J Pain Symptom Manage,2012,43(4):694-705.
[8]李金彪,朱菊英,王洁,等.丙泊酚复合芬太尼麻醉在胃镜检查的应用[J].临床麻醉学杂志,2009,25(6):527-528.
[9]王志华,陈勇,欧阳碧山,等.复合羟考酮时丙泊酚抑制无痛胃镜患者体动反应的ED50/ED95[J].海南医学,2017,28(10):1593-1595.
[10]唐作垒,吴畏.盐酸羟考酮预防麻醉诱导中芬太尼诱发患者咳嗽的效果[J].中华麻醉学杂志,2014,34(6):668-669.
[11]张杜枭,葛卫红,于锋,等.羟考酮临床治疗研究进展[J].药学与临床研究,2014,22(6):527-531.