文章摘要
羟考酮对腹腔神经丛射频消融术中心率变异性的影响
Effect of oxycodone in heart rate variability in celiac plexus radiofrequency ablation
  
DOI：10.12089/jca.2026.08.008
中文关键词: 射频消融术  腹腔神经丛  羟考酮  心率变异性  血清皮质醇
英文关键词: Radiofrequency ablation  Celiac plexus  Oxycodone  Heart rate variability  Serum cortisol
基金项目:恩泽疼痛管理医学研究项目（ezmr2022-019）
作者单位E-mail
李大桁 524001,广东省湛江市,广东医科大学附属医院疼痛科  
金相杰 524001,广东省湛江市,广东医科大学附属医院疼痛科  
黄敏 524001,广东省湛江市,广东医科大学附属医院疼痛科  
李楠 524001,广东省湛江市,广东医科大学附属医院疼痛科  
黄昕 524001,广东省湛江市,广东医科大学附属医院健康管理中心 lidahengdang@163.com 
摘要点击次数: 15
全文下载次数: 0
中文摘要:
      
目的： 探讨羟考酮在腹腔神经丛射频消融术中的临床效果。
方法： 选择确诊并接受治疗的恶性肿瘤腹部顽固性癌痛患者，年龄40～68岁，BMI 18.5～28.0 kg/m2，ASA Ⅰ—Ⅲ 级。随机将患者分为两组：试验组和对照组。患者接受经腹腔神经丛穿刺的射频消融术，试验组在手术开始后30 min静脉推注羟考酮0.1 mg/kg，对照组静脉推注等容量生理盐水。主要指标为术后24 h正常窦性RR间期的标准差(SDNN)。次要指标包括术后72 h内补救镇痛率、累计曲马多用量，术前1 d、术后24、72 h心率变异性指标，包括SDNN、相邻正常RR间期差值的均方根（RMSSD）、相邻RR间期差值＞50 ms的百分比（PNN50）、低频功率与高频功率比值（LF/HF），术前10 min、手术结束时、术后2、24 h血清皮质醇水平，术前1 d、术后24、72 h静息时VAS疼痛评分、Ramsay镇静评分和Richmond躁动评分。不良反应包括术后72 h内胃肠道反应、呼吸抑制、呼吸急促、头晕嗜睡、皮肤瘙痒、低血压和腹痛加重。
结果： 共纳入患者165例，试验组82例，对照组83例。与对照组比较，试验组术后住院时间明显缩短，补救镇痛率明显降低，累计曲马多用量明显减少；术后24、72 h SDNN、RMSSD、PNN50和Ramsay镇静评分明显升高，LF/HF、静息时VAS疼痛评分和Richmond躁动评分明显降低；手术结束时、术后2 h血清皮质醇水平明显降低（P＜0.05）。术前1 d两组心率变异性指标、静息时VAS疼痛评分、Ramsay镇静评分和Richmond躁动评分差异无统计学意义。术前10 min、术后24 h两组血清皮质醇水平差异无统计学意义。
结论： 羟考酮有助于减轻腹腔神经丛射频术患者的应激反应和术后疼痛，在确保用药安全的前提下改善患者术后镇静状态、降低躁动风险，为临床合理选择腹腔神经丛射频术的辅助用药提供了参考。
英文摘要:
      
Objective: To evaluate the effect of oxycodone in celiac plexus radiofrequency ablation.
Methods: Patients with pathologically confirmed malignant tumors and intractable abdominal cancer pain, aged 40-68 years, BMI 18.5-28.0 kg/m2, ASA physical status Ⅰ-Ⅲ, who were scheduled for celiac plexus radiofrequency ablation, were randomly divided into two groups: the experimental group and the control group. The experimental group received an intravenous bolus of oxycodone 0.1 mg/kg 30 minutes after the start of surgery, while the control group received an equal volume of normal saline. The primary outcome was standard deviation of normal-to-normal RR intervals (SDNN) 24 hours postoperatively. Secondary outcomes included the incidence of patients requiring rescue analgesia within 72 hours postoperatively, cumulative tramadol consumption, heart rate variability parameters 1 day preoperatively and 24 and 72 hours postoperatively, including SDNN, root mean square of successive differences (RMSSD), percentage of NN50 in total NN intervals (PNN50), ratio of low frequency and high frequency (LF/HF), serum cortisol levels 10 minutes preoperatively, at the end of surgery, and 2 and 24 hours postoperatively, as well as VAS pain score at rest, Ramsay sedation scale score, and Richmond agitation sedation scale score 1 day preoperatively and 24 and 72 hours postoperatively. Adverse events within 72 hours postoperatively comprised gastrointestinal reactions, respiratory depression, tachypnea, dizziness/somnolence, pruritus, hypotension, and aggravated abdominal pain.
Results: A total of 165 patients were enrolled, 82 patients in the experimental group and 83 patients in the control group. Compared with the control group, the experimental group had significantly shorter postoperative hospital stay, a significantly lower rate of rescue analgesia, and significantly less cumulative tramadol consumption, at 24 and 72 hours after surgery, the experimental group showed significantly higher SDNN, RMSSD, PNN50, and Ramsay sedation scale scores, and significantly lower LF/HF, VAS pain scores at rest, and Richmond agitation sedation scale scores. Serum cortisol levels in the experimental group were significantly lower at the end of surgery and 2 hours postoperatively (P < 0.05). No statistically significant differences were observed between the two groups in heart rate variability parameters, VAS pain scores at rest, Ramsay sedation scale scores, or Richmond agitation sedation scale scores 1 day preoperatively, nor in serum cortisol levels 10 minutes preoperatively or 24 hours postoperatively.
Conclusion: Oxycodone helps alleviate the stress response and postoperative pain in patients undergoing celiac plexus radiofrequency ablation. It improves the postoperative sedation status and reduces the risk of agitation while ensuring medication safety, thereby providing a reference for the rational clinical selection of adjuvant drugs for celiac plexus radiofrequency ablation.
查看全文   查看/发表评论  下载PDF阅读器
关闭