羟考酮预防硬膜外麻醉下阑尾切除术术中牵拉反应的效果观察

摘要

Objective To evaluate the preventive effect of oxycodone versus dezocine used for appendectomy in adults.Method Ninety acute appendicitis patients of ASA Ⅰ ～ Ⅱ,aged 23 ～50 years,were randomLy assigned to receive either intravenous oxycodone 0.1 mg/kg (Group O,n=30),dezocine 0.1 mg/kg (Group D,n=30) or equivalent saline (Group S,n=30) 15 min before incision.Assessment parameters included the incidence of stretch reflex-and drugs-related adverse events,such as dizziness,nausea,vomiting and bradycardia,as well as the number of patients who needed to receive additional analgesics when exploration and stretch.Besides,hemodynamics (MAP,HR,SpO2) were recorded when the patients transferred to the OR (T0),after epidural anesthesia(T1),incision(T2),exploration(T3),stretch(T4),and closing (T5).Results Compared with group S,the incidence of stretch reflex-related adverse events and the number of patients who needed to receive additional analgesics when exploration and stretch were significantly lower in group O and D (P＜0.05),but there was no statistical difference between group O and D (P＞0.05).A significantly lower incidence of drug-related dizziness and vomiting in group O was observed compared with group D (P＜0.05),while there was no statistical difference in vomiting and respiratory depression between group O and D (P＞0.05).Compared with group S,less hemodynamics fluctuation was observed in group O and D at T3 and T4 (P＜0.05).No statistical difference of hemodynamics at the other given time points (P＞0.05).Conclusion Intravenous oxycodone 0.1 mg/kg 15 min before the incision can safely inhibit the stretch reflex in patients undergoing appendectomy under epidural anesthesia with fewer incidences of dizziness and nausea than dezocine.%目的 观察并比较切皮前静脉给予羟考酮或地佐辛对阑尾切除术术中牵拉反应的预防作用. 方法 选取90名ASAⅠ～Ⅱ级、拟在硬膜外麻醉行阑尾切除术的患者.随机分为3组,即羟考酮组(O组)、地佐辛组(D组)和生理盐水对照组(S组).切皮前15 min,O组经静脉给予羟考酮0.1 mg/kg、D组经静脉给予地佐辛0.1 mg/kg、S组经静脉给予等量生理盐水.记录3组患者在探查和牵拉阑尾时牵拉反应和恶心呕吐的发生情况和需额外追加辅助药物的例数,观察入室(T0)、阻滞后(T1)、切皮(T2)、探查(T3)、牵拉阑尾(T4)和缝皮(T5)时的平均动脉压(MAP)、心率(HR)及脉搏氧饱和度(Sp()2). 结果 O,D组患者术中牵拉反应及其相关不良反应发生率和需额外追加静脉辅助药物的例数均显著低于S组(P＜0.05);而O组与D组比较,差别无统计学意义(P＞0.05).O组药物相关眩晕和恶心的发生率均显著低于D组(P＜0.05),而呕吐和呼吸抑制的发生率与D组比较,差别无统计学意义(P＞0.05);O组和D组MAP和HR均显著低于S组(P＜0.05),而O组与D组比较,差别无统计学意义(P＞0.05),其余各时间点3组MAP和HR比较,差别无统计学意义(P＜0.05);3组各时间点SpO2比较,差别无统计学意义(P＞0.05). 结论 在硬膜外麻醉行阑尾切除术切皮前15 min经静脉给予羟考酮0.1mg/kg可有效防止阑尾切除术中的牵拉反应,其效果与地佐辛相当,且眩晕及恶心等不良反应少.