羟考酮对腹腔镜胆囊切除术患者拔管期应激反应、术后疼痛的影响分析

摘要

目的 分析羟考酮对腹腔镜胆囊切除术患者拔管期应激反应、术后疼痛的影响分析.方法 收集行腹腔镜胆囊切除术治疗的患者120例,ASA分级为Ⅰ～Ⅱ级,根据随机数字表法分为4组(每组30例),A、B、C组分别于术前15min静脉注射0.1 mg/kg、0.15mg/kg、0.2mg/kg的羟考酮,D组静脉注射相同剂量的生理盐水.比较4组患者术后VAS评分、Ramsay镇静评分和炎性因子水平,并比较4组患者静脉注射羟考酮即刻(T1)、拔管即刻(T2)及拔管后5(T3)、10min(T4)的平均动脉压(MAP)、心率(HR)、血清肾上腺素(E)、皮质醇(Cor)水平.结果 C组拔管时间、苏醒时间明显高于A组、B组和D组(P＜0.05);B组、C组T2、T3时刻MAP、HR均明显低于A组和D组(P＜0.05);B组、C组T2、T3、T4时刻血清E、Cor水平明显低于A组和D组(P＜0.05);B组、C组术后1、2、6h的VAS评分明显低于A组和D组(P＜0.05);C组术后1、2、6h的Ram-say评分明显高于A组、B组和D组(P＜0.05);D组术后6、12h血IL-6水平均明显高于A组、B组和C组,术后6、12、24h血IL-10水平均明显高于A组、B组和C组(P＜0.05);B组、C组术后6、12h血IL-6水平均明显低于A组,IL-10水平均明显高于A组(P＜0.05);C组恶心呕吐、嗜睡、头晕发生率明显高于A组、B组和D组(P＜0.05).结论 腹腔镜胆囊切除术患者术前15min静脉注射0.15mg/kg的羟考酮,可更加有效减轻拔管期应激反应,改善了术后疼痛和炎症反应,且未增加不良反应的发生和拔管时间、苏醒时间,值得临床重视.%Objective To analyze the impact of oxycodone on stress reaction during tracheal extubation and postoperative pain in patients undergoing laparoscopic cholecystectomy.Methods 120 cases of patients with undergoing laparoscopic cholecystectomy were collected,ASA grade Ⅰ or Ⅱ,according to the random number table method were divided into 4 groups (each group of 30 cases),0.1 mg/kg,0.15 mg/kg and 0.2mg/kg oxycodone were administered intravenously 15 min before operation in group A,B and C,the the same dose of normal saline were administered intravenously in group D.The postoperative VAS score,Ramsay sedation score and inflammatory factor level were compared between the 4 groups,and the mean arterial blood pressure (MAP),heart rate (HR) and serum epinephrine (E),cortisol (Cor) levels were compared before injection(TI),during extubation(T2),5min(T3),10min(T4) after extubation.Results The extubation time,recovery time in group C were significantly higher than that of group A,B and D (P ＜ 0.05);The MAP,HR in group B,C were significantly lower than group A,D at T2,T3 moments (P ＜ 0.05);The serum E,Cor levels in group B,C were significantly lower than group A,D at T2,T3,T4 moments (P ＜ 0.05);The VAS score in group B,C were significantly lower than group A,D in postoperative 1,2,6h (P ＜ 0.05);The Ramsay score in group C were significantly higher than group A,B,D in postoperative 1,2,6h (P ＜ 0.05);The serum IL-6 level in group D were significantly higher than group A,B,C in postoperative 6,12h,the serum IL-10 level were significantly higher than group A,B,C in postoperative 6,12,24h (P ＜ 0.05);The serum IL-6 level in group B,C were significantly lower than group A,the serum IL-10 level were significantly higher than group A (P ＜ 0.05);The incidence of nausea,vomiting,drowsiness and dizziness were significantly higher than group A,B,D (P ＜ 0.05).Conclusion Undergoing laparoscopic cholecystectomy oxycodone 15min intravenous injection of 0.15mg/kg patients before surgery,can more effectively reduce the stress reaction during the extubation,improved postoperative pain and inflammation,and did not increase the occurrence of adverse reactions and pull tube time,recovery time,it is worthy of attention.