盐酸羟考酮用于肝细胞癌射频消融术中麻醉的前瞻随机对照研究

摘要

目的 探讨经皮肝细胞癌射频消融术中应用盐酸羟考酮的临床效果及安全性.方法 选择2015年3月至12月在北京大学肿瘤医院接受经皮肝细胞癌射频消融的患者60例,采用随机数字法分为盐酸羟考酮组(Q组)、芬太尼组(F组)和地佐辛组(D组),每组20例.分别于术前静脉滴注羟考酮0.1 mg/kg、芬太尼0.001 mg/kg、地佐辛0.1 mg/kg,待术者完成穿刺后给予丙泊酚维持麻醉.记录各组患者人手术室、射频消融开始时、射频消融开始后10 min、手术结束出针时和清醒时的平均动脉压、心率、呼吸频率、血氧饱和度;记录术中体动、呼吸抑制、恶心呕吐等并发症;记录术后疼痛评分.采用单因素方差分析、重复测量方差分析、SNK检验、x2检验等分析麻醉效果指标.结果 三组患者一般资料差异无统计学意义(P值均＞0.05).三组各时间点平均动脉压、心率和血氧饱和度差异均无统计学意义(P值均＞0.05).Q组、D组、F组射频消融开始时的呼吸频率分别为(11.7±1.6)次/min、(12.1±1.7)次/min、(10.3±2.3)次/min(F=5.068,P=0.009),射频消融开始后10 min的呼吸频率分别为(11.9±1.3)次/min、(12.2±1.4)次/min、(10.7±1.3)次/min(F=7.024,P=0.002),两两比较结果显示F组均低于Q组和D组(P＜0.05).Q组、D组、F组清醒后视觉模拟疼痛评分分别为0.2±0.7、0.3±0.7、1.7±1.5(F=12.981,P=0.000),术后lh视觉模拟疼痛评分分别为2.0±0.9、1.8±0.8、4.3±0.9(F=42.362,P=0.000),两两比较结果显示Q组和D组均低于F组(P＜0.05).术中体动Q组(3例)和D组(3例)少于F组(9例)(x2 =6.400,P=0.041).术中呼吸抑制Q组(3例)和D组(2例)低于F组(9例)(x2=8.012,P=0.018).结论 羟考酮注射液可以安全有效地用于肝脏射频消融术,术中血流动力学稳定,呼吸抑制发生率更低,在术后镇痛方面具有优势.%Objective To evaluate the clinical effect and safety of oxycodone hydrochloride in the anesthesia for percutaneous radiofrequency ablation (PRFA) in hepatocellular carcinoma.Methods Between March and December 2015,60 cases of hepatocellular carcinoma patients undergoing percutaneous radiofrequency ablation surgery in Peking University Cancer Hospital were randomly divided into three groups:oxycodone group (group Q),fentanyl group (group F) and dezocine group (group D),20 cases in each group.Respectively intravenously injection oxycodone 0.1 mg/kg,fentanyl 0.001 mg/kg,dezocine 0.1 mg/kg before surgery.After the surgeon completed puncture administer propofol to maintain anesthesia.Recorded mean arterial pressure (MAP),heart rate (HR),respiratory rate (RR),oxygen saturation (SpO2) changes in each group at entrance,beginning of radiofrequency ablation (T1),radiofrequency ablation began after 10 minutes (T2),the end of the surgical and awake.Observe the analgesia effect,respiratory depression,nausea,vomit and other complications.Postoperative pain scores were recorded.Using ANOVA,repeated measure variance analysis,SNK test,x2 test and other tests to evaluate the anesthetic effect indexes.Results The observation completed in all patients.Patients of three groups had no significant differences in general information.No significant difference between MAP,HR and SpO2 at each time points among the three groups.At the T1 time point (group Q:(11.7 ± 1.6)/min,group D:(12.1 ±l.7)/min,group F:(10.3 ±2.3)/min,F=5.068,P =0.009) and T2 time point (group Q:(11.9±1.3)/min,group D:(12.2±1.4)/min,group F:(1O.7±.1.3)/min,F=7.024,P=0.O02),RR in group F were lower than in group Q and group D.Pain visual analogue scores after waking (group Q:0.2 ±0.7,group D:O.3 ±0.7,group F:1.7 ± 1.5,F=12.981,P =0.000) and postoperative pain score of 1 hour (group Q:2.0 ± 0.9,group D:1.8 ± O.8,group F:4.3 ± 0.9,F =42.362,P =0.000) in the group Q and group D were significantly lower than in group F.The body movements in group Q and group D were significantly less than in group F (3 cases,3 cases,9 cases,x2 =6.400,P =0.041).Intraoperative respiratory depression in group Q and group D were lower than group F (3 cases,2 cases,9 cases,x2 =8.012,P =0.018).Conclusions Oxycodone hydrochloride can be used safely and effectively for radiofrequency ablation.It has favorable hemodynamic stability,lower incidence of respiratory depression,and advantage in terms of postoperative pain.