盐酸羟考酮复合右美托咪啶在超声引导下肝癌射频消融术中的应用

Clinical application of oxycodone combined with dexmedetomidine in percutaneous ultrasound-guided radiofrequency ablation of hepatocellular carcinomas

目的观察羟考酮注射液复合右美托咪啶在超声引导下肝癌射频消融术中的应用效果。方法选择超声引导下肝癌射频消融术患者60例，肿瘤大小均≤3cm，肝功能Child分级A级。随机均分为两组：芬太尼（A组）和羟考酮组（B组），每组30例。A组静注芬太尼2μg/kg，B组静注羟考酬0．2mg/kg。两组均静脉泵注右美托咪啶0．5μg/kg（10min注射完），10min后右美托咪啶以0．2μg·kg-1·h-1维持至手术结束。监测入室时（T0）、射频开始时（T1）、射频开始后10min（T2）、手术结束时（T3），术屙15min（T4）的心率（HR）、平均动脉压（MAP）、血氧饱和度（SPO2）、脑电双频指数（BIS）。评估阴组恶心呕吐、呼吸抑制、术中体动等不良反应的发生率。评估1、0、T3、术后1h的VAS（视觉模拟评分法）疼痛评分。结果A组有5例患者在术中出现体动，血压升高，心率增快，给予静注芬太尼2μg/kg后好转。两组患者1、2时间点心率较阳相比有显著减慢（P〈0．05）。两组间各时间点的MAP、HR、SPO2、BIS相比差异无统计学意义（P〉0．05）。B组恶心呕吐、呼吸抑制及术中体动的发生率明显低于A组（P〈0．05）。T3、术后1hB组患者的VAS评分明显低于A组（P〈0．05）。结论羟考酮复合右美托咪啶可安全有效地应用于超声引导下肝癌射频消融术，镇痛效果良好，不良反廊发生牢低。

Objective To explore the effects of oxycodone combined with dexmedetomidine in percutaneous ultrasound-guided radiofrequency ablation of hepatocellular carcinomas. Methods Sixty palients who underwent percutanenus uhrasound-guided radiofrequeney ablation of hepatocellular carcinomas were randomly divided into feutanyl group （group A） and oxycodone group （ group B ）, with 30 patients in each group. Patients in group A were injected with fentanyl （2 μg/kg）, and patients in group B were injected with oxycodone （0. 2 mg/kg）. All the patients were injected with dexmedetomidine, with a loading dose of 0. 5 μg/kg for 10 minutes and a continuous iufusion rate of 0. 2 μg · kg · h-1 until the end of the operation. The changes of heart rate （HR）, mean arterial pressure （MAP）, pulse oxygen saturation （SPO2 ） and bispectral index （BIS） were monitored at different time points： time when patients entering the operating room （ TO ） , the beginning of operation （ T1 ） , 10 minutes after operation （ T2 ） , the end of operation （T3） , 15 minules after the end of operation （T4）. The incidence of side effects （nausea and vomiting, respiratory depression and body movements ） was assessed. The visual analogue scale （VAS） scores were also recorded at T0, T3 and an hour postoperatively. Results Five patients of Group A had the body movements during the operation, amt it was improved after injecting with fentanyl 2 μg/kg. Compared with TO, HR in two gronps decreased significantly at T2 （P 〈 0. 05）. At each time point, the difference of MAP, HR, SPO2 and BIS was not statistically significant in two groups. The incidence of Nausea and vomiting, body movements was lower in group B than that in group A（P 〈 0. 05 ）. The VAS scores were lower in group B than that in group A at T3 and an hour postoperatively （ P 〈 0. 05 ）. Conclusion The combination of oxycodone and dexmedetomidine can be used safely and effectively in percutaneous ultrasound-guided radiofrequency ablation of hepatocellular carcinomas, and it shows more effective analgesia and less side-effects.