| 陶嘉斌,苏 喆,王 艳,徐珂嘉,王跃军,张光明.预防性应用不同剂量羟考酮对腹腔镜胆囊手术拔管期应激反应的影响[J].,2018,(16):3072-3075 |
| 预防性应用不同剂量羟考酮对腹腔镜胆囊手术拔管期应激反应的影响 |
| Effects of Preventive use of Different Doses of Oxycodone on the Stress Response during Tracheal Extubation in Laparoscopic Cholecystectomy |
| 投稿时间：2018-01-22 修订日期：2018-02-15 |
| DOI：10.13241/j.cnki.pmb.2018.16.015 |
| 中文关键词: 腹腔镜胆囊手术 羟考酮 剂量 拔管期 应激反应 |
| 英文关键词: Laparoscopic cholecystectomy Oxycodone Dose Tracheal extubation Stress response |
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| 摘要 目的：探讨预防性应用不同剂量羟考酮对腹腔镜胆囊手术(laparoscopic cholecystectomy，LC)拔管期应激反应的影响。方法：将75例接受LC的患者随机分为低、中、高剂量组，每组均25例。术毕15 min，低、中、高剂量组分别预防性静脉注射盐酸羟考酮0.1 mg/kg、0.15 mg/kg、0.2 mg/kg。比较各组拔管前(T1)、拔管时(T2)、拔管后5 min(T3)、拔管后10 min(T4)、拔管后30 min(T5)血流动力学改变、麻醉苏醒时间、拔管情况及不良反应的发生情况。结果：与T1时刻比较，各组T2时刻收缩压(systolic blood pressure，SBP)、舒张压(diastolic blood pressure，DBP)、心率(heart rate，HR)均明显升高(P<0.05)，但中、高剂量组T3时刻后SBP、DBP、HR均显著下降，恢复至T1时刻水平(P>0.05)，各指标水平明显低于低剂量组(P<0.05)。中剂量组与高剂量组各指标比较差异均无统计学意义(P>0.05)。随着剂量羟考酮的增加，患者苏醒时间、拔管时间逐渐延长(P<0.05)；中、高剂量组拔管质量评分显著低于低剂量组(P<0.05)，而中、高剂量组间拔管质量评分比较差异无显著性(P>0.05)。高剂量组恶心呕吐、呼吸抑制的发生率明显高于低剂量组，中、高剂量组追加镇痛药物的比例明显低于低剂量组(P<0.05)。结论：预防性使用羟考酮可不同程度抑制LC术后拔管期应激反应，0.15 mg/kg羟考酮能够更好地维持患者血流动力学的稳定，促进患者早期苏醒，且安全性较高。 |
| 英文摘要: |
| ABSTRACT Objective: To explore the effects of preventive use of different dose of oxycodone on the stress response during tracheal extubation in laparoscopic cholecystectomy(LC). Methods: 75 patients with LC surgery were randomly divided into low, medium and high dose group, 25 cases in each group. 15 min at end of operation, low, medium and high dose group was preventively given oxycodone hydrochloride 0.1 mg/kg, 0.15 mg/kg, 0.2 mg/kg, respectively. The hemodynamic change, anesthesia waking time, tracheal extubation and the occurrence of adverse reactions among each group before extubation(T1), during extubation(T2), at 5 min after extubation(T3) and 10 min after extubation(T4) were Compared. Results: Compared with T1 time point, the SBP, DBP, HR in T2 time point were significantly increased in each group (P<0.05), but after T3 time point, the SBP, DBP, HR in medium and high dose group had dropped significantly, returned to the level of T1 time point (P>0.05), the level of all indexes were significantly lower than those in low dose group (P<0.05). There were no statistically significant difference on all indexes between medium dose group and high dose group(P > 0.05). With the increase of oxycodone dose, awakening time, extubation time is longer (P<0.05). The extubation quality scores in medium and high dose group were significantly lower than those in low dose group (P<0.05), while the high dose group had no significant difference with low dose group(P<0.05). The incidences of nausea and vomiting, respiratory depression in high dose group were obviously higher than those in medium and low dose group, the proportion of additional analgesic drugs in middle and high dose group was significantly lower than that in low dose group (P<0.05). Conclusion: Prophylactic use of oxycodone can restrain stress response during tracheal extubation in LC at different degree, dose of oxycodone 0.15 mg/kg can be better to maintain hemodynamic stability, promote the early awakening, reduce incidence of adverse reactions, and safe to use. |
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