盐酸羟考酮用于烧伤削痂植皮术围术期麻醉管理的效果观察

Effect evaluation of oxycodone hydrochloride in perioperative management of burn patients undergoing tangential excision and I skin grafting

目的 探讨盐酸羟考酮应用于烧伤削痂植皮术患者围术期麻醉管理的临床效果。方法 选取2022年3-9月在解放军总医院第四医学中心全身麻醉下行削痂植皮术患者80例,随机分为舒芬太尼组和盐酸羟考酮组,其中舒芬太尼组44例,盐酸羟考酮组36例。舒芬太尼组麻醉诱导采用舒芬太尼(0.2 μg/kg)、咪达唑仑(0.02 mg/kg)、依托咪酯(0.1 mg/kg)、丙泊酚(1 mg/kg)及罗库溴铵(1 mg/kg),术中采用静脉吸入复合维持麻醉,追加舒芬太尼5 μg/次,术后应用患者自控静脉镇痛泵(patient controlled intravenous analgesia, PCIA)给予舒芬太尼(2 μg/kg)+地塞米松(10 mg);盐酸羟考酮组麻醉诱导采用盐酸羟考酮(0.08 mg/kg),其余诱导和维持药物同舒芬太尼组,术中追加盐酸羟考酮2 mg/次,术后应用PCIA,予盐酸羟考酮(0.6 mg/kg)+地塞米松(10 mg)。记录和比较两组患者基本资料,基础值(T1)、入室时(T2)、麻醉诱导插管后2 min(T3)、手术取皮时(T4)、植皮时(T5)、出室时(T6)的MAP、HR及其变化率(△MAP、△HR),不同时点的焦虑自评量表(self-rating anxiety scale, SAS)评分、焦虑和疼痛的视觉模拟评分(visual analogue score, VAS),以及术后不良反应发生情况。结果 80例患者中,男47例,女33例,平均年龄(44.2±11.4)岁。两组不同时间点MAP和HR的比较,差异均无统计学意义(P> 0.05);与舒芬太尼组相比,盐酸羟考酮组术中各时点的△MAP较低,其中T4和T5的差异有统计学意义(P <0.05);两组各时点△HR的差异均无统计学意义(P> 0.05)。两组术前、术后焦虑SAS评分和焦虑VAS的差异均无统计学意义(P> 0.05)。与舒芬太尼组相比,盐酸羟考酮组术后24 h和48 h疼痛VAS较低[1.00(0.00,2.00)分比2.00(1.00, 3.00)分,0.00(0.00, 1.00)分比1.00(0.00, 2.00)分];不良反应总体发生率较低(16.7%比43.2%),差异均有统计学意义(P <0.05)。结论 盐酸羟考酮可用于烧伤削痂植皮术患者的围术期全程麻醉镇痛管理,循环更稳定,镇痛效果较好,不良反应较少。

Objective To explore the clinical effect of oxycodone hydrochloride in perioperative anesthesia management of burn patients.Methods A total of 80 patients underwent tangential excision and skin grafing under general anesthesia in the Fourth Medical Center of PLA General Hospital from March to September 2022 were selected,and were randomly divided into sufentanil group(n=44)and oxycodone hydrochloride group(n=36).In sufentanil group,sufentanil(0.2μg/kg),midazolam(0.02 mg/kg),etomidate(0.1 mg/kg),propofol(1 mg/kg)and rocuronium(1 mg/kg)were used for anesthesia induction,intravenous inhalation was used to maintain anesthesia and sufentanil was added 5μg/time,the patient controlled intravenous analgesia(PCIA)pump was used to give sufentanil(2μg/kg)and dexamethasone(10 mg)after operation.In the oxycodone hydrochloride group,anesthesia was induced with oxycodone hydrochloride(0.08 mg/kg),and the other induction and maintenance drugs were the same as sufentanil group,oxycodone hydrochloride(2 mg/time)was added during the surgery,PCIA was applied and oxycodone hydrochloride(0.6 mg/kg)and dexamethasone(10 mg)were given after the surgery.The basic data of the two groups were recorded and compared,including MAP,HR,and the change rates(△MAP,HR)of the baseline value(T1),the time of entering the operation room(T2),2 min after anesthesia induction intubation(T3),the time of skin harvesting(T4),the time of skin grafting(T5),and the time of leaving the operation room(T6).Self-rating anxiety scale(SAS)score,visual analogue score(VAS)of anxiety and pain at different time points,and the occurrence of adverse reactions were recorded and analyzed.Results There were 47 males and 33 females with an avearge age of(44.2±11.4)years.There were no significant difference in MAP and HR between the two groups at different time points(P>0.05).Compared with the sufentanil group,oxycodone hydrochloride group had lower rates of△MAP at each time point during operation,and the differences between T4 and T5 were statistically significant(P<0.05).There were no significant differences in△HR between the two groups(P>0.05).There were no significant differences in SAS and VAS scores between the two groups before and after operation(P>0.05).Compared with the sufentanil group,hydrochloride group had lower VAS at 24 h and 48 h after operation[1.00(0.00,2.00)score vs.2.00(1.00,3.00)score,0.00(0.00,1.00)score vs.1.00(0.00,2.00)score],and lower overall incidence of adverse reactions(16.7%vs.43.2%),and the differences were statistically significant(all P<0.05).Conclusions Oxycodone hydrochloride can be used in the whole perioperative anesthesia and analgesia management of burn patients undergoing tangential excision and skin grafing,with more stable circulation,better analgesic effect and less adverse reactions.