羟考酮预防性镇痛及麻醉维持在老年舌颌颈联合根治术中应用效果

Effect of oxycodone preventive analgesia and anesthesia maintenance in elderly patients undergoing tongue,jaw and neck combined radical operation

目的探讨盐酸羟考酮预防性镇痛及麻醉维持对老年舌颌颈联合根治术患者应激反应、镇痛及安全性的影响。方法选取2021年7月至2022年6月在唐山市协和医院拟行舌颌颈联合根治术的老年患者152例,年龄60~80岁,采用奇偶数法随机分为两组,奇数纳入羟考酮组,偶数纳入对照组,每组各76例。羟考酮组术中静脉滴注丙泊酚+盐酸羟考酮麻醉维持,术毕前15 min静注盐酸羟考酮预防性镇痛;对照组术中静脉滴注丙泊酚+瑞芬太尼麻醉维持,术毕前15 min静注舒芬太尼预防性镇痛。比较两组不同时刻血流动力学参数、血清应激指标水平、镇痛评分及不良反应。结果切皮时、术毕即刻及术后2 h,羟考酮组平均动脉压及心率均低于对照组(P<0.05)。术毕即刻及术后1 d,两组去甲肾上腺素(NE)、肾上腺素(E)、皮质醇(Cor)水平均较术前升高,但羟考酮组上述因子水平均低于对照组(P<0.05)。术后6、12、24、48 h,两组疼痛视觉模拟评分(NRS)均较术后2 h降低,且羟考酮组低于对照组(P<0.05)。羟考酮组术后自主呼吸恢复时间、苏醒时间较对照组缩短,24 h内镇痛泵按压次数较对照组减少(P<0.05)。羟考酮组术后不良反应发生率为7.89%,低于对照组的21.05%(P<0.05)。结论盐酸羟考酮预防性镇痛及麻醉维持可有效抑制老年舌颌颈联合根治术患者应激反应,缓解疼痛,且能维持围术期血流动力学稳定,安全性好。

Objective To investigate the effects of oxycodone hydrochloride preventive analgesia and anesthesia maintenance on stress response,analgesia and safety inelderly patients undergoing combined tongue,jaw and neck radical operation.Methods 152 elderly patients aged from 60to80 years old who planned to undergo tongue,jaw and neck combined radical mastectomy in the hospital from July 2021 to June 2022,the patientswere prospectively selected and randomly divided into 2 groups by odd-even method.The odd number was included in oxycodone group,and the even number was included in control group,with 76 cases in each group.Intraoperative intravenous propofol+oxycodone hydrochloride for maintenance of anaesthesia in the oxycodone group,and oxycodone hydrochloride was intravenously injected for pre-analgesia 15 min before the end of operation.Intraoperative intravenous propofol+remifentanil for maintenance of anaesthesia in control group,and sufentanil was intravenously injected for pre-analgesia 15 min before the end of the operation.Hemodynamic parameters,serum stress indexes,analgesia scores at different time points and adverse reactions were compared between the two groups.Results The mean arterial pressure and heart rate in the oxycodone group were lower than those in control group at skin cutting,immediately after the operation and 2 hours after the operation(P<0.05).Immediately after the operation and one day after the operation,the levels of noradrenaline(NE),epinephrine(E)and cortisol(Cor)in the two groups were higher than those before the operation,but the levels of these factors in the oxycodone group were lower than those in control group(P<0.05).At 6,12,24,and 48 hours after theoperation,the visual analogue score(NRS)of the two groups was significantly lower than that of the 2 h after the operation,and the oxycodone group was lower than that ofcontrol group(P<0.05).The recovery time and recovery time of spontaneous breathing after the operation in oxycodone group was shorter than those in control group,and the times of analgesic pump pressing within 24 hours were lower than those in control group(P<0.05).The incidence of postoperative adverse reactions in oxycodone group was 7.89%,which was lower than 21.05%in control group(P<0.05).Conclusion Oxycodone hydrochloride prophylactic analgesia and anaesthetic maintenance can effectively suppress the stress response and relieve pain in elderly patients undergoing combined lingual-mandibular-cervical radical surgery,and maintain hemodynamic stability in perioperative period with good safety.