羟考酮复合雷米芬太尼在经皮肝穿刺射频消融术中的应用

Application of oxycodone combined with remifentanil in patients undergoing percutaneous hepaticr adiofrequency ablation

目的探讨羟考酮复合雷米芬太尼在经皮肝穿刺射频消融术(RFA)的应用效果。方法行超声引导下经皮肝穿刺RFA肝癌患者60例,随机均分为羟考酮复合雷米芬太尼组(OR组)和丙泊酚组(P组)。OR组术前5min缓慢推注羟考酮0.05mg/kg,术中持续输注雷米芬太尼0.10~0.20μg·kg^(-1)·min^(-1);P组术前5min缓慢推注丙泊酚1mg/kg,术中持续输注丙泊酚2mg·kg^(-1)·h^(-1)。观察入室时(T0)、麻醉后5min(T1)、经皮肝穿刺置入电极(T2)、RFA开始(T3)、RFA结束(T4)和RFA结束后10min(T5)两组患者HR、MAP、RR、SpO_2。RFA结束后30min,行VAS疼痛评分,记录不良反应发生情况。结果 OR组T0~T5各时间点HR、MAP、RR、SpO2稳定。与OR组比较,P组T1、T4的MAP下降,T4的RR、SpO_2下降(P<0.05)。RFA结束后30min,OR组VAS疼痛评分低于P组(P<0.05)。OR组呼吸抑制发生率低于P组(P<0.05)。结论羟考酮复合雷米芬太尼镇痛能有效、安全应用于经皮肝穿刺RFA。

Objective To investigate the application of oxycodone hydrochloride combined with remifentanil in the patients undergoing ultrasound-guided percutaneous radiofrequency ablation（RFA）for hepatic cancer.Methods Sixty patients undergoing percutaneous hepatic RFA were equally randomized into two groups.Analgesia was performed with an injection of oxycodone 0.05mg/kg at5 minutes before RFA and infusion of remifentanil 0.10-0.20μg·kg^-1· min^-1（group OR）or an injection of propofol 1.0mg/kg and infusion of propofol 2mg·kg^-1·h^-1（group P）.The HR,MAP,RR and SpO2 were recorded before anesthesia（T0）,at the beginning of the procedure（T1）,during the probe placement（T2）and RFA（T3）,at the end of RFA（T4）and 10 minutes after the end of RFA（T5）.VAS pain score was evaluated at 30 minutes after the end of RFA.The adverse effects were observed as well.Results The HR,MAP,RR and SpO2 in group OR were all stable at T0-T5.Compared to group OR,MAP at T1 and T4 and RR and SpO2 at T4 in group P were lower（P〈0.05）.VAS pain score at 30 minutes after the end of RFA was less in group OR than that in group P（P〈0.05）.The incidence of respiratory depression was lower in group OR than that in group P（P〈0.05）.Conclusion Analgesia with combined use of oxycodone and remifentanil can be used effectively and safely in the patients undergoing percutaneous hepatic RFA.