羟考酮预处理在肥胖患者腹腔镜袖状胃切除术中的应用
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摘要
目的观察羟考酮用于肥胖患者腹腔镜袖状胃切除术中降低胃切割刺激的作用。方法择期全身麻醉下行腹腔镜袖状胃切除术肥胖患者60例随机均分为三组,气腹建立后分别静脉注射羟考酮0.1 mg/kg(Q组)、芬太尼1μg/kg(F组)和等容量生理盐水(C组)。分别于入室时(T0)、气腹建立后(T1)、袖状胃切除开始(T2)、袖状胃切除5 min(T3)、袖状胃切除完毕(T4)和手术结束时(T5)记录患者的HR和MAP,记录患者的苏醒时间、拔管时间、术后30 min的VAS疼痛评分、不良反应发生情况、术后排气时间和住院天数。结果 Q组T2～T5时的HR、T3～T4时的MAP和术后30 min的VAS疼痛评分均低于C组,住院天数短于C组(P<0.05)。F组术后30 min的VAS疼痛评分低于C组(P<0.05)。Q组T3～T4时的HR和MAP以及术后30 min的VAS内脏痛评分均低于F组,苏醒时间、拔管时间和住院天数均短于F组(P<0.05)。结论羟考酮预处理用于肥胖患者腹腔镜袖状胃切除术可以有效减轻内脏牵拉痛和维持术中血流动力学稳定。
Objective To observe the effect of oxycodone on reducing gastric incision stimulation during laparoscopic sleeve gastrectomy in obese patients.Methods Sixty obese patients undergoing elective laparoscopic sleeve gastrectomy under general anesthesia were randomly and equally divided into three groups.After establishment of pneumoperitoneum,the patients of group Q were treated with intravenous injection of oxycodone 0.1 mg/kg,those of group F with fentanyl 1 μg/kg and those of group C with same volume of normal saline.Heart rate(HR) and mean arterial pressure(MAP) were recorded at the time of entering operation room(T0),pneumoperitoneum establishment(T1),the beginning of sleeve gastrectomy(T2),5 minutes after sleeve gastrectomy(T3),the end of sleeve gastrectomy(T4) and the end of operation(T5),respectively.The recovery time,extubation time,VAS pain score at 30 minutes after operation,the incidence of adverse responses,postoperative exhaust time and hospitalization stay were recorded.Results HR at T2 to T5,MAP at T3 to T4 and VAS pain score at 30 minutes after operation were lower and hospitalization stay was shorter in group Q than those in group C(P<0.05).The VAS pain score in group F was less than that in group C(P<0.05).HR and MAP at T3 to T4 and VAS score of visceral pain at 30 minutes after operation were less in group Q than those in group F(P<0.05).The recovery time,extubation time and hospitalization stay were also shorter in group Q than those in group F(P<0.05).ConclusionOxycodone pretreatment can effectively alleviate the visceral traction pain and maintain intraoperative hemodynamic stability in obese patients undergoing laparoscopic sleeve gastrectomy.
Objective To observe the effect of oxycodone on reducing gastric incision stimulation during laparoscopic sleeve gastrectomy in obese patients.Methods Sixty obese patients undergoing elective laparoscopic sleeve gastrectomy under general anesthesia were randomly and equally divided into three groups.After establishment of pneumoperitoneum,the patients of group Q were treated with intravenous injection of oxycodone 0.1 mg/kg,those of group F with fentanyl 1 μg/kg and those of group C with same volume of normal saline.Heart rate(HR) and mean arterial pressure(MAP) were recorded at the time of entering operation room(T0),pneumoperitoneum establishment(T1),the beginning of sleeve gastrectomy(T2),5 minutes after sleeve gastrectomy(T3),the end of sleeve gastrectomy(T4) and the end of operation(T5),respectively.The recovery time,extubation time,VAS pain score at 30 minutes after operation,the incidence of adverse responses,postoperative exhaust time and hospitalization stay were recorded.Results HR at T2 to T5,MAP at T3 to T4 and VAS pain score at 30 minutes after operation were lower and hospitalization stay was shorter in group Q than those in group C(P<0.05).The VAS pain score in group F was less than that in group C(P<0.05).HR and MAP at T3 to T4 and VAS score of visceral pain at 30 minutes after operation were less in group Q than those in group F(P<0.05).The recovery time,extubation time and hospitalization stay were also shorter in group Q than those in group F(P<0.05).ConclusionOxycodone pretreatment can effectively alleviate the visceral traction pain and maintain intraoperative hemodynamic stability in obese patients undergoing laparoscopic sleeve gastrectomy.
引文
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[7] 孙加晓,杨雅婷,谢文吉,等.羟考酮、舒芬太尼和芬太尼用于术后镇痛对结肠癌患者免疫功能的影响[J].临床麻醉学杂志,2018,34(5):421-424.
[8] 张彤,樊成能,陈奕.羟考酮对选择性痔上黏膜吻合术患者术中抗牵拉反应的效果[J].江苏医药,2018,44(8):944-945.
[9] 廖丁卫,张郃,董文理,等.腹腔镜手术后羟考酮与芬太尼静脉自控镇痛对疼痛程度、免疫应答及应激反应的影响[J].海南医学院学报,2018,24(8):845-848.
[10] 王承志,甘建辉,涂青,等.盐酸羟考酮注射液对腹腔镜下结肠癌根治术患者围术期应激因子的影响[J].中国医药导刊,2017,19(12):1352-1355.
[2] Linares OA,Daly D,Linares AD,et al.Personalized oxycodone dosing:using pharmacogenetic testing and clinical pharmacokinetics to reduce toxicity risk and increase effectiveness[J].Pain Med,2014,15(5):791-806.
[3] Park KB,Ann J,Lee H.Effect of different dosages of oxycodone and fentanyl on the hemodynamic changes during intubation[J].Saudi Med J,2016,37(8):847-852.
[4] Leonetti F,Capoccia D,Coccia F,et al.Obesity,type 2 diabetes mellitus,and other comorbidities:a prospective cohort study of laparoscopic sleeve gastrectomy vs medical treatment[J].Arch Surg,2012,147(8):694-700.
[5] Olkkola KT,Kontinen VK,Saari TI,et al.Does the pharmacology of oxycodone justify its increasing use as an analgesic[J]?Trends Pharmacol Sci,2013,34(4):206-214.
[6] 吴周全,邹志清,陈勇.不同剂量羟考酮对腹部手术后急性疼痛的抑制作用[J].临床麻醉学杂志,2015,31(2):161-163.
[7] 孙加晓,杨雅婷,谢文吉,等.羟考酮、舒芬太尼和芬太尼用于术后镇痛对结肠癌患者免疫功能的影响[J].临床麻醉学杂志,2018,34(5):421-424.
[8] 张彤,樊成能,陈奕.羟考酮对选择性痔上黏膜吻合术患者术中抗牵拉反应的效果[J].江苏医药,2018,44(8):944-945.
[9] 廖丁卫,张郃,董文理,等.腹腔镜手术后羟考酮与芬太尼静脉自控镇痛对疼痛程度、免疫应答及应激反应的影响[J].海南医学院学报,2018,24(8):845-848.
[10] 王承志,甘建辉,涂青,等.盐酸羟考酮注射液对腹腔镜下结肠癌根治术患者围术期应激因子的影响[J].中国医药导刊,2017,19(12):1352-1355.