羟考酮对累及肝脏包膜经皮肝穿刺微波消融术肝癌患者的影响

Effect of oxycodone on percutaneous microwave ablation of liver cancer abutting capsule

目的探讨羟考酮用于经皮肝癌微波消融术消融范围累及肝脏包膜的临床效果及安全性。方法选择择期行经皮肝癌微波消融术消融范围累及肝脏包膜的患者38例,男32例,女6例,年龄41~75岁,ASAⅠ或Ⅱ级。采用随机数字表法分为羟考酮组(O组,n=20)和芬太尼组(F组,n=18)。穿刺前O组静脉注射羟考酮0.1mg/kg,F组静脉注射芬太尼1μg/kg。穿刺成功后,两组均静脉注射丙泊酚1.5mg/kg行麻醉诱导,后以丙泊酚4~7 mg·kg^(-1)·h^(-1)维持麻醉。记录术前、术中、术后MAP、HR、SpO_2和RR的变化;观察术中体动反应、呼吸抑制和术后恶心呕吐的发生情况;记录微波消融功率、微波消融时间、麻醉时间、手术总时间、丙泊酚用量等消融手术术中情况及术后4h内VAS评分。结果两组患者一般情况和消融手术术中情况差异均无统计学意义。F组术中体动反应及呼吸抑制发生率明显高于O组(P<0.05)。两组患者术后恶心呕吐发生率差异无统计学意义。术后4h内VAS评分F组(3.9±2.0)分明显高于O组(1.7±0.9)分(P<0.01)。两组患者术前、术中、术后HR比较差异无统计学意义。与术前比较,术中F组MAP明显升高(P<0.05),F组和O组RR明显减慢(P<0.01或P<0.05)。术中F组RR明显慢于O组(P<0.05),而术前和术后两组RR差异无统计学意义。结论羟考酮可以安全用于消融范围累及肝脏包膜的经皮肝癌微波消融术,有效控制术中爆发性内脏痛、减少呼吸抑制的发生、降低术后疼痛。

Objective To evaluate the clinical effect and safety of oxycodone in the anesthesia for percutaneous microwave ablation（PMWA）in liver cancer when the scope of ablation involving liver capsule.Methods Thirty-eight patients scheduled for percutaneous microwave ablation of liver cancer abutting capsule,including 32 males and 6females,aged 41-75 years,with ASA gradeⅠ orⅡ.Patients were randomly divided into 2groups：oxycodone group（group O,n=20）and fentanyl group（group F,n=18）.Before the puncture,a loading dose of oxycodone 0.1mg/kg was given intravenously in group O,a loading dose of fentanyl 1μg/kg was given intravenously in group F.After successful puncture,both groups were induced by Propofol 1.5mg/kg,followed by Propofol infusion at 4-7mg·kg^（-1）·h^（-1） in two groups.The changes of MAP,HR,SpO_2 and RR before,during and after operation were recorded.Body movement and respiratory depression were recorded.The total amount of propofol,the postoperative recovery time,postoperative nausea and vomiting,and postoperative 4h VAS scores were recorded.Results There was no significant difference in general condition and intraoperative condition of ablation operation between the two groups.The incidences of respiratory depression and body movement in group F were significantly higher than those in group O.There was no significant difference in the incidences of postoperative nausea and vomiting between the two groups.VAS score 4hafter operation in group F [（3.9±2.0）score]was significantly higher than that in group O [（1.7±0.9）score]（P〈0.01）.There was no significant difference in HR between the two groups at each point.Compared with before surgery,the MAP during surgery in group F was significantly increased（P〈0.05）,the RR during surgery in groups F and O were significantly lower（P〈0.01 or P〈0.05）.The RR during surgery in group F was significantly lower than that in group O（P〈0.05）,but there was no significant difference at the other points between the two groups.Conclusion Oxycodone can be used safely and effectively for percutaneous microwave ablation of liver cancer when the scope of ablation involving liver capsule.It has lower incidence of respiratory depression,effectively alleviates intraoperative pain and reduces postoperative pain.