羟考酮联合右美托咪定用于腹腔镜下结肠癌根治术术后镇痛效果评价

doi:10.13481/j.1671-587x.20170630

吉林大学学报(医学版) ›› 2017, Vol. 43 ›› Issue (06): 1231-1236.doi: 10.13481/j.1671-587x.20170630

羟考酮联合右美托咪定用于腹腔镜下结肠癌根治术术后镇痛效果评价

王波^1,2, 沈倩倩³, 张华², 冯智英¹

1. 浙江大学医学院附属第一医院麻醉科&疼痛科, 浙江杭州 310003;
2. 浙江省杭州市第三人民医院麻醉科, 浙江杭州 310003;
3. 浙江省杭州市第三人民医院外科, 浙江杭州 310003

收稿日期:2017-02-28 出版日期:2017-11-28 发布日期:2017-12-01
通讯作者: 冯智英,主任医师,硕士研究生导师(Tel:0571-87236857,E-mail:fzy1972@zju.edu.cn) E-mail:fzy1972@zju.edu.cn
作者简介:王波(1986-),男,安徽省芜湖市人,主治医师,主要从事围手术期疼痛和神经病理性疼痛方面的研究。
基金资助:
浙江省中医药管理局科研项目资助课题（2016ZB067）

Evaluation on postoperative analgesia efficacy of oxycodone combined with dexmedetomidine in patients underwent laparoscopic radical surgery of colon cancer

WANG Bo^1,2, SHEN Qianqian³, ZHANG Hua², FENG Zhiying¹

1. Department of Anesthesiology and Pain Medicine, First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou 310003, China;
2. Department of Anesthesiology, Third People's Hospital of Hangzhou City, Zhejiang Provinece, Hangzhou 310003, China;
3. Department of Surgery, Third people's Hospital of Hangzhou City, Hangzhou 310003, China

Received:2017-02-28 Online:2017-11-28 Published:2017-12-01

摘要/Abstract

摘要： 目的：观察羟考酮联合右美托咪定用于腹腔镜下结肠癌根治术术后镇痛的有效性和安全性。方法：选择腹腔镜下结肠癌根治术术后使用静脉自控镇痛患者60例，采用信封法随机分为对照组和实验组（n=30）。对照组药物为0.5 mg·kg^-1羟考酮，实验组药物为0.5 mg·kg^-1羟考酮加2μg·kg^-1右美托咪定。2组药物均用生理盐水稀释至100 mL并装入镇痛泵，维持量为1 mL·h^-1，单次剂量为1.5 mL，锁定时间为10 min。记录2组患者在送麻醉后恢复室（T₁）及术后6（T₂）、12（T₃）、24（T₄）和48 h （T₅）时活动痛及静息痛的疼痛视觉模拟（VAS）评分、镇痛泵药物用量、镇痛急救措施次数及术后首次肛门排气时间；观察2组患者术后不良反应、生命体征及Ramsay镇静评分。结果：实验组患者T₂~T₅时活动痛及T₂~T₄时静息痛VAS评分明显低于对照组（活动痛：P_T2~T5=0.000；静息痛：P_T2=0.018，P_T3=0.001，P_T4=0.010）；实验组患者镇痛泵药物用量和紧急镇痛措施次数明显少于对照组（P=0.000；P=0.029）；实验组患者术后肛门排气时间明显早于对照组（P=0.030）；实验组患者恶心发生例数明显少于对照组（P=0.023），2组患者术后48 h内其他不良反应发生率比较差异无统计学意义（P>0.05）。结论：羟考酮联合右美托咪定可以安全有效地应用于腹腔镜下结肠癌根治术术后镇痛。

关键词: 羟考酮, 右美托咪定, 术后镇痛, 结肠肿瘤

Abstract: Objective:To evaluate the efficacy and safety of oxycodone combined with dexmedetomidine in the postoperative analgesia in the patients underwent laparoscopic radical surgery of colon cancer. Methods:Sixty colon cancer patients underwent laparoscopic radical surgery and recevied patient-controlled intravenous analgesia after operation were randomly divided into control group and experiment group(n=30) using The "Envelope Method".The patients in control group were given 0.5 mg·kg^-1 oxycodone, and the patients in experiment group were given 0.5 mg·kg^-1 oxycodone and 2 μg·kg^-1 dexmedetomidine. The parameters of analgesic pump in two groups were set as follows:the continuous perfusion rate was 1 mL·h^-1,the single bolus was 1.5 mL, the lock-out time was 10 min,and the total volume was 100 mL. The VAS scores of pain at rest and activity pain of the patients in two groups were evaluated at exiting the post anesthesia care unit (T₁), and at 6 h (T₂), 12 h (T₃), 24 h (T₄) and 48 h (T₅) after operation. The dose of analgesic drugs used, times of emergent rescue analgesia and anus exhaust time after operation of the patients in two groups were recorded; the postoperative adverse responses,vital signs and Ramsay scores of the patients in two groups were observed. Results:The VAS scores of activity pain at T₂-T₅ and pain at rest at T₂-T₄ of the patients in experiment group(P_T2-T5=0.000;P_T2=0.018,P_T3=0.001,P_T4=0.010) were lower than those in control group;the doses of analgesic drugs used and times of emergent rescue analgesia of the patients in experiment group were significantly lower than those in control group(P=0.000,P=0.029);the anus exhaust time after operation was significantly earlier than that in control group(P=0.030);the cases of nausea of the patients in experiment group were significantly lower than that in control group(P=0.023),and there were no significantly differences in the other various adverse effects of the patients between two groups(P>0.05). Conclusion:Oxycodone combined with dexmedetomidine is effective and safe for the postoperative analgesia after laparoscopic radical surgery of colon cancer.

Key words: postoperative analgesia, dexmedetomidine, colon neoplasms, oxycodone

中图分类号:

R735.25

王波, 沈倩倩, 张华, 冯智英. 羟考酮联合右美托咪定用于腹腔镜下结肠癌根治术术后镇痛效果评价[J]. 吉林大学学报(医学版), 2017, 43(06): 1231-1236.

WANG Bo, SHEN Qianqian, ZHANG Hua, FENG Zhiying. Evaluation on postoperative analgesia efficacy of oxycodone combined with dexmedetomidine in patients underwent laparoscopic radical surgery of colon cancer[J]. Journal of Jilin University Medicine Edition, 2017, 43(06): 1231-1236.

参考文献

[1] Kehlet H, Slim K. The future of fast-track surgery[J]. Br J Surg,2012,99(8):1025-1026.
[2] 许幸, 吴新民, 薛张纲,等. 盐酸羟考酮注射液用于全麻患者术后镇痛的有效性和安全性前瞻性、随机、盲法、多中心、阳性对照临床研究[J].中华麻醉学杂志,2013,33(3):269-274.
[3] Bob Y, Heechan K, Yanna S, et al. Perioperative applications of dexmedetomidine:from bench to beside[J]. JClin Anesthesiol,2011,27(10):1034-1040.
[4] Staahl C,Dimcevski G,Andersen SD,et al.Differential effect of opioids in patients with chronic pancreatitis:an experimental pain study[J].Scand J Ganstroenterol,2007,42(3):383-390.
[5] Wheeler M, Oderda GM, Ashburn MA, et al.Adverse events associated with postoperative opioid analgesia:a systematic review[J].Pain, 2002,3(3):159-180.
[6] Helal SM, Eskandr AM, Gaballah KM, et al. Effects of perineural administration of dexmedetomidine in combination with bupivacaine in a femoral-sciatic nerve block[J]. Saudi J Anaesth,2016,10(1):18-24.
[7] Ge DJ, Qi B, Tang G, et al. Intraoperative dexmedetomidine promotes post-operative analgesia in patients after abdominal colectomy:a consort-prospective, randomized, controlled clinical trial[J].Medicine (Baltimore), 2015,94(37):e1514.
[8] Funai Y, Pickering AE, Uta D, et al.Systemic dexmedetomidine augments inhibitory synaptic transmission in the superficial dorsal horn through activation of descending noradrenergic control:an in vivo patch-clamp analysis of analgesic mechanisms[J]. Pain,2014,155(3):617-628.
[9] Mahendru V, Tewari A, Katyal S, et al. A comparison of intrathecal dexmedetomidine, clonidine, and fentanyl as adjuvants to hyperbaric bupivacaine for lower limb surgery:A double blind controlled study[J]. J Anaesthesiol Clin Pharmacol,2013,29(4):496-502.
[10] Ren CG, Chi MY, Zhang YW, et al. Dexmedetomidine in post-operative analgesia in patients undergoing hysterectomy:A CONSORT-prospective, randomized, controlled trial[J]. Medicine (Baltimore), 2015,94(32):e1348.
[11] 李铁军,马飞,曾德茁,等.右美托咪定辅助舒芬太尼用于腰椎内固定术后镇痛的观察[J].中国疼痛医学杂志,2015,21(3):235-237.
[12] 刘超,张磊.经脐单孔腹腔镜胆囊切除术治疗急性胆囊炎的效果评价[J]. 临床肝胆病杂志,2015,31(10):1678-1681.

[1]	王廷刚, 薛峰, 李宇, 牛兆健, 王野. miR-26a靶向HMGA1基因对结肠癌细胞生长、侵袭和迁移的影响[J]. 吉林大学学报(医学版), 2018, 44(06): 1205-1211.
[2]	侯海龙, 唐颖, 曲兴龙, 华树成. 右美托咪定联合无创通气治疗AECOPD并发肺性脑病患者的临床疗效及安全性评价[J]. 吉林大学学报(医学版), 2018, 44(05): 1014-1019.
[3]	周刘祥, 林琳, 胡鑫敏, 王晓春. 内分泌腺性血管内皮生长因子对结肠癌LoVo细胞增殖和迁移的促进作用[J]. 吉林大学学报(医学版), 2018, 44(03): 516-520.
[4]	曹雪峰, 赵亮, 刘旭东, 李艳, 甄瑞鑫, 段凤梅, 刘玉伶. 右美托咪定非静脉给药对下腹部及下肢手术患儿的镇静效果[J]. 吉林大学学报(医学版), 2018, 44(02): 388-393.
[5]	王玥, 刘畅, 朴仙姬, 张冬云, 孟令旗, 王浩, 王加茹, 罗英花, 孙虎男, 金成浩. 四溴苯三唑对人结肠癌SW480细胞凋亡的诱导作用及其机制[J]. 吉林大学学报(医学版), 2017, 43(06): 1148-1154.
[6]	曹艳莎, 李婳, 陈明红, 刘宝琴, 王华芹, 李宁. 组织芯片技术检测BAG3蛋白在结肠癌组织中的表达及其临床意义[J]. 吉林大学学报(医学版), 2017, 43(06): 1177-1181.
[7]	石俊忠, 庄建彬, 张传山, 刘贤明, 孔大陆. β-tubulin Ⅲ在结肠腺癌组织中的表达及其临床意义[J]. 吉林大学学报(医学版), 2017, 43(04): 770-775.
[8]	刘婕婷, 夏鑫, 申希平, 王迎斌. 罗哌卡因联合地佐辛多模式镇痛在小儿唇裂修复术中的应用及其术后镇痛效果评价[J]. 吉林大学学报(医学版), 2016, 42(04): 807-812.
[9]	刘红梅, 杨莉. 子宫切除术前给予右美托咪定对患者应激和免疫功能的影响[J]. 吉林大学学报(医学版), 2015, 41(06): 1245-1248.
[10]	陈伟莉, 张晨, 张旭浩, 刘冬影, 赵玺. 紫薯花青素抗结肠癌作用及其诱导细胞凋亡机制[J]. 吉林大学学报(医学版), 2015, 41(04): 785-789.
[11]	姜恩平, 李贺, 于春艳, 朱伟. 五味子乙素通过p38MAPK信号通路对结肠癌SW480细胞凋亡和侵袭的影响[J]. 吉林大学学报(医学版), 2015, 41(04): 675-679.
[12]	张成才, 宋艳艳, 周梦娇, 崔志倩, 张西臣, 邢沈阳. RNA干扰YWHAZ基因对结肠癌HCT-8细胞增殖的影响[J]. 吉林大学学报(医学版), 2015, 41(02): 307-310.
[13]	刘晓康, 韩欣冶, 林英嘉, 胡方舟, 李杨, 李清. 桦木醇对人结肠癌SW480细胞增殖和凋亡的影响[J]. 吉林大学学报(医学版), 2015, 41(01): 39-43.
[14]	王海莉，李晓莹，韩笑，安丽萍，关晓辉. ASPP家族在结肠癌组织中的表达及其临床意义[J]. 吉林大学学报(医学版), 2014, 40(03): 659-663.
[15]	张霞，张秀梅，肖建英 . 靶向CK2α基因的siRNA对结肠癌HCT116细胞生长抑制作用及其机制[J]. 吉林大学学报(医学版), 2014, 40(03): 621-625.

羟考酮联合右美托咪定用于腹腔镜下结肠癌根治术术后镇痛效果评价

Evaluation on postoperative analgesia efficacy of oxycodone combined with dexmedetomidine in patients underwent laparoscopic radical surgery of colon cancer

RichHTML

PDF (PC)

赞

可视化

摘要/Abstract

引用本文

使用本文

参考文献

相关文章 15

Metrics

本文评价

推荐阅读 0