不同剂量羟考酮联合右美托咪定镇痛对经皮肾镜取石术全麻患者术后并发症及痛感的影响

Effects of different doses of oxycodone combined with dexmedetomidine on postoperative complications and pain in patients undergoing percutaneous nephrolithotomy under general anesthesia

目的探讨不同剂量羟考酮联合右美托咪定镇痛对经皮肾镜取石术全麻患者术后并发症及痛感的影响,为临床应用提供参考。方法选取2018年8月至2019年12月在本院全麻行经皮肾镜取石术患者120例,随机将其分为四组,每组30例。四组患者均采用自控镇痛泵镇痛,其右美托咪定剂量0.4μg/kg-1镇痛为对照组、0.1 mg羟考酮联合0.4μg/kg-1右美托咪定镇痛为A组,0.15 mg羟考酮联合0.4μg/kg-1右美托咪定为B组、0.2 mg羟考酮联合0.4μg/kg-1右美托咪定镇痛为C组。比较四组患者术后1 h(T0)、6 h(T1)、12 h(T2)、24 h(T3)、48 h(T4)平均动脉压(MAP)、心率(HR)、视觉模拟评分法(VAS)评分、谵妄分级评分量表(DRS)及术后不良反应出现情况。结果四组患者T1、T2 MAP、HR与T0比较,差异均有统计学意义(均P<0.05);T3、T4 MAP、HR与T0比较,差异均无统计学意义(均P>0.05);C组T1、T2 MAP、HR均显著高于对照组、A、B组,差异均有统计学意义(均P<0.05);对照组、A、B组T1 MAP、HR比较,差异无统计学意义(P>0.05);B、C组T0、T1、T2、T3 DRS、VAS评分均低于A组、对照组,差异均有统计学意义(均P<0.05);A组、对照组T4时DRS、VAS评分显著降低,差异均有统计学意义(均P<0.05);四组患者T4时DRS、VAS评分比较,差异均无统计学意义(均P>0.05);A组高血压发生率为23.33%,显著高于B、C、对照组0.00%、0.00%、6.67%,差异有统计学意义(P<0.05);C组心动过速、呼吸抑制、低血压发生率显著高于A、B、对照组,差异均有统计学意义(均P<0.05);四组患者术后恶心、恶吐发生率比较,差异均无统计学意义(均P>0.05);B组与对照组各不良反应发生率比较,差异均无统计学意义(均P>0.05)。结论不同剂量羟考酮联合右美托咪定镇痛对经皮肾镜取石术全麻患者术后血流动力学均造成一定影响,但随着时间推移逐渐减弱,0.15 mg羟考酮联合0.4μg/kg-1右美托咪定可减少术后谵妄,术后镇痛效果良好,不良反应少,具有较高的临床推广价值。

Objective To explore the effects of different doses of oxycodone combined with dexmedetomidine on postoperative complications and pain in patients undergoing percutaneous nephrolithotomy under general anesthesia.Methods 120 patients who took percutaneous nephrolithotomy under general anesthesia at our hospital from August,2018 to December,2019 were randomly divided into a control group,group A,group B,and group C,with 30 cases in each group.All the patients in the four groups were treated with self-controlled analgesia pump.0.4μg·kg-1 dexmedetomidine was given in the control group,0.10 mg oxycodone combined with 0.4μg·kg-1 dexmedetomidine in group A,0.15 mg oxycodone combined with 0.4μg·kg-1 dexmedetomidine in group B,and 0.20 mg oxycodone combined with 0.4μg·kg-1 dexmedetomidine in group C.The mean arterial pressure(MAP),heart rate(HR),visual analogue scale(VAS),delirium Rating Scale(DRS),and adverse reactions were compared between the 4 groups.Results The MAP and HR at T1 and T2 were statistical different from those at T0 in the four groups(all P<0.05),but those at T3 and T4 were not(all P>0.05).At T1 and T2,the MAP and HR were higher in group C than in the control group,group A,and group B(P<0.05).There were no statistical differences in MAP and HR at T1 between the control group,group A,and group B(all P>0.05).At T0,T1,T2,and T3,the scores of DRS and VAS were lower in group B and group C than in the control group(all P<0.05).At T4,the scores of DRS and VAS decreased significantly in the control group and group A(all P<0.05).There were no statistical differences in the scores of DRS and VAS between the 4 groups(P>0.05).The incidence of hypertension was higher in group A than in group B,group C,and the control group(23.33%vs.0.00%,0.00%,and 6.67%;all P<0.05).The incidences of tachycardia,respiratory depression,and hypotension in group C was significantly higher than those in group A,group B,and the control group(all P<0.05).There were no statistical differences in the incidences of postoperative nausea and vomiting between the four groups(all P>0.05).There were no statistical differences in the incidences of the adverse reactions between group B and the control group(all P>0.05).Conclusion Different doses of oxycodone combined with dexmedetomidine have some effects on the hemodynamics of patients after percutaneous nephrolithotomy under general anesthesia of,but the effects gradually weaken as time passes.0.15 mg oxycodone combined with 0.4μg·kg-1 dexmedetomidine can reduce postoperative delirium.The effect of postoperative analgesia is good,with fewer adverse reactions,and has a high clinical value.