静脉泵注羟考酮对腹腔镜胰十二指肠切除术患者苏醒期疼痛及全身应激反应的影响

Effect of continuous intravenous infusion of oxycodone on pain and systemic stress response in recovery of laparoscopic pancreaticoduodenectomy operation

目的观察术中静脉微量泵注羟考酮对腹腔镜胰十二指肠切除术患者苏醒期疼痛及全身应激反应程度的影响。方法选择择期接受腹腔镜胰十二指肠切除术的患者60例,随机分为0.1 mg/kg羟考酮静脉泵注组(OCI组)和0.1 mg/kg羟考酮静脉注射组(OI组)。采用视觉模拟评分量表(VAS)和Ramsay评分分别评价患者拔管即刻(T2)、拔管后5 min(T3)、拔管后15 min(T4)及离开PACU时(T5)的疼痛和镇静程度。分别测定2组患者麻醉诱导前(T1)、T2、T3时间点血清中垂体-靶腺轴相关激素、血管活性相关激素的含量。结果在T2-T5时间点,OCI组内脏VAS疼痛评分低于OI组,差异有统计学意义(P<0.05)。在T3-T5时间点,OI组Ramsay评分高于OCI组,差异有统计学意义(P<0.05)。在T2及T3时间点,OCI组血清促甲状腺激素(TSH)、促肾上腺皮质激素(ACTH)、皮质醇(Cor)、去甲肾上腺素(NE)、肾上腺素(E)、血管紧张素-Ⅱ(AT-Ⅱ)的含量均低于OI组,差异有统计学意义(P<0.05)。结论术中静脉泵注0.1 mg/kg羟考酮可有效缓解腹腔镜胰十二指肠切除术患者苏醒期内脏疼痛并抑制全身应激反应。

Objective To investigate the effect of intraoperative continuous intravenous infusion of oxycodone on pain and systemic stress response in patients undergoing laparoscopic pancreatoduodenectomy.Methods Sixty patients scheduled for laparoscopic pancreatoduodenectomy were randomly divided into 0.1 mg/kg oxycodone continuous intravenous infusion group(OCI group)and 0.1 mg/kg oxycodone intravenous injection group(OI group).Visual analogue scale(VAS)pain score and Ramsay score were used to evaluate the pain and sedation of patients immediately after extubation(T2),5 min after extubation(T3),15 min after extubation(T4)and leaving post-anesthesia care unit(PACU,T5).The serum levels of pituitary-target gland axis-related hormones and vasoactive hormones before anesthesia induction(T1),T2 and T3 were measured.Results At T2-T5,the visceral VAS pain score in the OCI group was lower than that in the OI group(P<0.05).At T3-T5,the Ramsay score of the OI group was significantly higher than that of the OCI group(P<0.05).At T2 and T3,the serum thyroid-stimulating hormone(TSH),adrenocorticotrophic hormone(ACTH),cortisol(Cor),norepinephrine(NE),epinephrine(E),and angiotensinⅡ(AT-Ⅱ)in the OCI group were significantly lower than that in the OI group(P<0.05).Conclusions Intraoperative continuous intravenous infusion of 0.1 mg/kg oxycodone can effectively relieve visceral pain and restrain systemic stress response in patients undergoing laparoscopic pancreatoduodenectomy.