Yao Y Q, Liu Y H, Fan Z Y, Chen J H, Dong C J
Department of Anesthesiology, Peking University Cancer Hospital & Institute, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Beijing 100142, China.
Zhonghua Wai Ke Za Zhi. 2016 Oct 1;54(10):772-775. doi: 10.3760/cma.j.issn.0529-5815.2016.10.010.
To evaluate the clinical effect and safety of oxycodone hydrochloride in the anesthesia for percutaneous radiofrequency ablation (PRFA) in hepatocellular carcinoma. 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 (SpO) 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, χ test and other tests to evaluate the anesthetic effect indexes. The observation completed in all patients. Patients of three groups had no significant differences in general information. No significant difference between MAP, HR and SpO at each time points among the three groups. At the T1 time point (group Q: (11.7±1.6)/min, group D: (12.1±1.7)/min, group F: (10.3±2.3)/min, =5.068, =0.009) and T2 time point (group Q: (11.9±1.3)/min, group D: (12.2±1.4)/min, group F: (10.7±1.3)/min, =7.024, =0.002), 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: 0.3±0.7, group F: 1.7±1.5, =12.981, =0.000) and postoperative pain score of 1 hour (group Q: 2.0±0.9, group D: 1.8±0.8, group F: 4.3±0.9, =42.362, =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, χ=6.400, =0.041 ). Intraoperative respiratory depression in group Q and group D were lower than group F (3 cases, 2 cases, 9 cases, χ=8.012, =0.018). 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.
评估盐酸羟考酮在肝细胞癌经皮射频消融术(PRFA)麻醉中的临床效果及安全性。2015年3月至12月,北京大学肿瘤医院60例行经皮射频消融术的肝细胞癌患者随机分为三组:羟考酮组(Q组)、芬太尼组(F组)和地佐辛组(D组),每组20例。术前分别静脉注射羟考酮0.1mg/kg、芬太尼0.001mg/kg、地佐辛0.1mg/kg。待手术医生完成穿刺后给予丙泊酚维持麻醉。记录每组患者入室时、射频消融开始时(T1)、射频消融开始后10分钟(T2)、手术结束时及清醒时的平均动脉压(MAP)、心率(HR)、呼吸频率(RR)、血氧饱和度(SpO)变化。观察镇痛效果、呼吸抑制、恶心、呕吐等并发症。记录术后疼痛评分。采用方差分析、重复测量方差分析、SNK检验、χ²检验等进行麻醉效果指标评估。所有患者均完成观察。三组患者一般资料无显著差异。三组各时间点MAP、HR及SpO无显著差异。在T1时间点(Q组:(11.7±1.6)/次/分钟,D组:(12.1±1.7)/次/分钟,F组:(10.3±2.3)/次/分钟,F =5.068,P =0.009)和T2时间点(Q组:(11.9±1.3)/次/分钟,D组:(12.2±1.4)/次/分钟,F组:(10.7±1.3)/次/分钟,F =7.024,P =0.002),F组RR低于Q组和D组。清醒后疼痛视觉模拟评分(Q组:0.2±0.7,D组:0.3±0.7,F组:1.7±1.5,F =12.981,P =0.000)及术后1小时疼痛评分(Q组:2.0±0.9,D组:1.8±0.8,F组:4.3±0.9,F =42.36,2,P =0.000),Q组和D组均显著低于F组。Q组和D组体动明显少于F组(3例、3例、9例,χ²=6.400,P =0.041)。术中Q组和D组呼吸抑制低于F组(3例、2例、9例,χ²=8.012,P =0.018)。盐酸羟考酮可安全有效地用于射频消融术。其血流动力学稳定性良好,呼吸抑制发生率较低,术后疼痛方面具有优势。