盐酸羟考酮对腹腔镜胆囊切除患者术后P物质、5-HT的影响

The influence of oxycodone to substance P and 5-HT in postoperative patients with laparoscopic cholecystectomy

①目的观察盐酸羟考酮对腹腔镜胆囊切除患者术后P物质、5-羟色胺(5-HT)和苏醒期安全性的影响,探讨其镇痛效果和安全性。②方法对满足条件的患者按手术先后顺序进行编号,随机数字表中选取数字进行奇偶数分组:羟考酮组(O组),芬太尼组(F组)。术中采用全凭静脉麻醉方法。缝皮前O组给予羟考酮0.1mg/kg,F组给予芬太尼0.001μg/kg。抽取麻醉诱导前(T0)、拔管即刻(T1)、拔管后5分钟(T2)、出恢复室(T3)四个时间点外周静脉血,用ELISA法测定血清中P物质和5-HT;记录T0、T1和T2患者心率(HR)、平均动脉压(MAP)、血氧饱和度(SpO2);记录患者苏醒期的躁动情况,按轻度、中度和重度给予分级。应用SPSS 13.0软件进行数据分析。③结果 O组P物质和5-HT在T1、T2、T3均较F组低;苏醒期O组躁动发生率少、程度轻,对HR、MAP的影响小,血氧饱和度不受影响。④结论腹腔镜胆囊切除患者术毕前应用羟考酮,不延迟患者苏醒、不影响拔管,能减少血流动力学波动、降低躁动发生率,降低P物质和5-HT的释放,有较高的安全性,可稳定麻醉苏醒期的循环,有效缓解疼痛。

Objective To study the effect of oxycodone to substance P,5-HT and the safety of the awakening period,and to discuss oxycodone analgesic efficacy and safety.Methods The patients who met the conditions according to the operation sequence numbered,and group the patients by the parity of the number in selected random number table,oxycodone group （O group）,fentanyl group （F group）.Intraoperative used of intravenous anesthesia method.Before sewing leather,O group intrave-nously administered oxycodone 0.1mg/kg,F group received fentanyl 0.001μg/kg.Extracted the pe-ripheral venous blood at four time points：before induction of anesthesia（T0 ）,extubating immediate （T1）,extubated 5min（T2）,out of the recovery room（T3）.Measured the value of 5-HT and substance P in serum with ELISA method.Recorded the value of the patient＇s heart rate （HR）,mean arterial pressure （MAP）,blood oxygen saturation （SpO2 ）at three time points：T0 ,T1 ,T2 .Recorded the pa-tient agitation after regained consciousness,according to the mild,moderate and severe classification. Using SPSS 13.0 software for data analysis.Results Substance P and 5-HT in O group compared with F group was rising slowly before and after extubation.When out of the recovery room,recovery period of O group the incidence of agitation rate was small,light degree,and had small affect on HR and MAP,meanwhile the SpO2 was unaffected.Conclusion Using the oxycodone before the end of laparoscopiccholecystectomy will not delay patients regained consciousness and not affect the extubation,it can reduce the hemodynamic fluctuations and the incidence of agitation and reduce the release of sub-stance P and 5-HT with higher security,it can stable anesthesia awakening period of circulation and effectively alleviate the pain.