文章摘要

不同时间点应用羟考酮对全身麻醉术后痛觉过敏的预防及治疗

作者: 1黄政坤, 1沈杰, 1施海明, 1张云仙, 1苏海丰
1 江苏省原子医学研究所附属江原医院麻醉科,江苏 无锡 214063
通讯: 沈杰 Email: 13616145850@163.com
DOI: 10.3978/j.issn.2095-6959.2020.08.028
基金: 江苏省原子医学研究所青年基金(QN201709)。

摘要

目的:观察不同时间点给予羟考酮注射液对术后痛觉过敏的防治效果。方法:选择全身麻醉下行择期甲状腺癌根治术患者90例, 年龄18~65岁,男22例,女68例,美国麻醉医师协会分级(American Society of Anesthesiologists,ASA)I~II级。将患者随机分为3组:术前10 min给予羟考酮组(A组,n=30)、术毕前10 min给予羟考酮组(B组,n=30)、对照组(C组,n=30)。3组患者均给予盐酸戊乙奎醚0.01 mg/kg,咪达唑仑0.02~0.03 mg/kg,阿曲库铵0.15 mg/kg,瑞芬太尼1 μg/kg,丙泊酚2~2.5 mg/kg,在Narcotrend指数(NTI)<46后,经口明视行气管插管,机械通气。术中维持NTS在D1~E0,即NTI为27~56,根据Narcotrend监测调整丙泊酚的泵注速度,瑞芬太尼以0.2 μg/kg/min恒速输注至手术结束。分别记录麻醉时间、苏醒时间、术中瑞芬太尼的使用剂量、手术前后的冷痛阈值、术后疼痛VAS评分和Ramsay镇静评分、术后恶心、呕吐及呼吸抑制的发生率。结果:与C组相比,A组和B组术后视觉模拟(Visual Analogue Scale,VAS)评分明显降低(P<0.05)。C组出现痛觉过敏,术后痛阈值低于术前(P<0.05),A组术前及术后痛阈值为(38.2±1.8) s和(39.1±1.9) s,B组术前及术后痛阈值为(38.9±1.5) s和(42.1±2.3) s,两组术前痛阈值差异无统计学意义(P>0.05)、术后痛阈值差异有统计学意义(P<0.05)。与C组比较,术后的Ramsay镇静评分、恶心、呕吐及呼吸抑制发生率差异无统计学意义(P>0.05)。结论:术毕前10 min给予羟考酮能更好地预防全身麻醉术后的痛觉过敏,改善患者的术后疼痛,不增加患者术后恶心、呕吐等不良反应。
关键词: 不同时间点;羟考酮;痛觉过敏;全身麻醉

Prevention and treatment of hyperalgesia after general anesthesia with oxycodone at different time points

Authors: 1HUANG Zhengkun, 1SHEN Jie, 1SHI Haiming, 1ZHANG Yunxian, 1SU Haifeng
1 Department of Anesthesia, Jiangyuan Hospital Affiliated to Jiangsu Institute of Nuclear Medicine, Wuxi Jiangsu 214063, China

CorrespondingAuthor: SHEN Jie Email: 13616145850@163.com

DOI: 10.3978/j.issn.2095-6959.2020.08.028

Foundation: This work was supported by Youth Fund of Jiangsu Institute of Nuclear Medicine, China (QN201709).

Abstract

Objective: To observe the effect of oxycodone injection on postoperative hyperalgesia at different time points. Methods: Ninety patients aged 18–65 years old with selective radical thyroidectomy under general anesthesia were selected. There were 22 males and 68 females with American Society of Anesthesiologists (ASA) grade I or II. The patients were randomly divided into three groups: the oxycodone group (group A, n=30) 10 minutes before operation, the oxycodone group (group B, n=30) 10 minutes before operation and the control group (group C, n=30). Penehyclidine hydrochloride 0.01 mg/kg, midazolam 0.02–0.03 mg/kg, atracurium 0.15 mg/kg, remifentanil 1 μg/kg, propofol 2–2.5 mg/kg were given to all three groups. After the Narcotrend index (NTI) <46, tracheal intubation and mechanical ventilation were performed throμgh oral intubation. NTS was maintained at D1-E0, i.e., NTI was at 27–56. The pump speed of propofol was adjusted according to Narcotrend monitoring. Remifentanil was infused at a constant rate of 0.2 μg/kg/min until the end of the operation. The anesthesia time, recovery time, intraoperative dosage of remifentanil, cold pain threshold before and after operation, VAS score and Ramsay sedation score, incidence of nausea, vomiting and respiratory depression after operation were recorded. Results: Compared with control group C, the VAS scores of group A and group B were significantly lower (P<0.05). The pain threshold of control group was lower than that of preoperative group (P<0.05). The pain threshold of group A was (38.2±1.8) s and (39.1±1.9) s before and after operation, and that of group B was (38.9±1.5) s and (42.1±2.3) s before and after operation. There was no significant difference between the two groups in preoperative pain threshold (P>0.05) and postoperative pain threshold (P<0.05). Compared with the control group, there was no significant difference in Ramsay sedation score, nausea, vomiting and respiratory depression (P>0.05). Conclusion: Oxycodone given 10 minutes before the end of operation can better prevent hyperalgesia after general anesthesia, and improve the postoperative pain of patients, without increasing postoperative nausea and vomiting adverse reactions.
Keywords: different time points; oxycodone; hyperalgesia; general anesthesia