悬雍垂腭咽成形术后羟考酮镇痛对糖尿病患者应激反应的影响

Effects of oxycodone early analgesia on stress response in patients undergoing uvulopalatopharyngoplasty

目的：探讨悬雍垂腭咽成形术（UPPP）后应用羟考酮镇痛对糖尿病患者应激反应的影响。方法选择择期行悬雍垂腭咽成形术的睡眠呼吸暂停综合征患者80例,男53例,女27例,年龄28~65岁,ASA Ⅰ或Ⅱ级。随机分为两组,每组40例。手术结束前15 min,O 组静脉注射羟考酮0.07 mg/kg,F 组静脉注射芬太尼0.7μg/kg。分别在术晨（T1）、术后1 h（T2）、3 h（T3）抽取静脉血3 ml,采用电化学发光法检测血清皮质醇（Cor）、胰岛素（Ins）和 C 肽（C-P）浓度。结果与 T1时比较,T2、T3时 O 组 Cor 浓度明显降低,C-P 浓度明显升高（P 〈0.05）,F 组 Cor 浓度明显升高,C-P 明显降低（P 〈0.05）,且 F 组 Cor 浓度明显高于 O 组,C-P 浓度明显低于 O 组（P 〈0.05）；T2、T3时 F组 Ins 浓度明显降低,且明显低于 O 组（P 〈0.05）。结论糖尿病患者 UPPP 术后羟考酮0.07 mg/kg 镇痛明显抑制了应激反应。

Objective To study effects of oxycodone post-operative early analgesia on stress re-sponse with in diabetics undergoing uvulopalatopharyngoplasty （UPPP）.Methods Eighty patients undergoing UPPP,53 males,27 females,aged 28-65 years,ASA Ⅰ or Ⅱ were randomly divided in-to two groups（n =40）.1 5 minutes before the end of the operation,group O was intravenously given oxycodone 0.07 mg/kg;Group F fentanyl 0.7 μg/kg.The patients of the two groups were sampled venous blood 3 ml in the morning of operation （T1 ）,postoperative 1 hour （T2 ）,postoperative 3 hours （T3 ）for determination of serum cortisol （Cor）,serum insulin（Ins）,serum C-peptide（C-P）u-sing electrochemical luminescence method.Results Cor at T2 ,T3 was lower than that at T1 , C-P was higher than that at T1 （P 〈0.05）in group O,respectively;Cor at T2 ,T3 was higher than that at T1 , respectively,C-P was lower than that at T1 （P 〈0.05）;Cor in group F was higher than that in group O,C-P in group F was lower than that in group O（P 〈0.05）.Ins at T2 ,T3 was lower than that at T1 and was lower than that in group O（P 〈0.05）.Conclusion Oxycodone 0.07 mg/kg early analgesia for UPPP significantly inhibits the occurrence of stress response.