Page 108 - 南京医科大学学报自然科学版

南京医科大学学报（自然科学版） 第43卷第12期
·1724 · Journal of Nanjing Medical University（Natural Sciences） 2023年12月

·临床研究·

羟考酮联合丙泊酚用于乳腺癌保乳手术静脉全麻的临床效果

评估

王玉东 ，刘育贤 ，卞清明 ，刘 辉 1，2*
1
1
1，2
徐州医科大学麻醉学院，江苏 徐州 221004；江苏省肿瘤医院，江苏省肿瘤防治研究所，南京医科大学附属肿瘤医院麻醉
1 2
科，江苏 南京 210009

［摘 要］ 目的：评估羟考酮联合丙泊酚用于全凭静脉麻醉对乳腺癌保乳手术患者术中全麻效果、围手术期不良反应和镇痛
效果的影响。方法：选择美国麻醉医师协会（American Society of Anesthesiologists，ASA）评分Ⅰ或Ⅱ级，年龄26~61岁，体重指
数 19~28 kg/m ，择期行乳腺癌保乳手术的患者 80 例，随机分为芬太尼组和羟考酮组，每组 40 例。记录两组患者麻醉诱导前
2
（T0 ）、气管插管前即刻（T1 ）、手术开始时（T2 ）、切除乳腺标本时（T3 ）、手术结束时（T4 ）的收缩压、舒张压、心率；术后2 h 、6 h、24
h、48 h 静息状态及运动时的疼痛数字评分（numerical rating scale，NRS）；患者清醒时间、拔管时间、丙泊酚用量；观察两组患者
诱导期咳嗽反射、术中知晓、术中低血压、术后躁动、恶心呕吐、皮肤瘙痒等不良反应的发生率。结果：T2、T3时羟考酮组收缩
压、舒张压、心率均显著高于芬太尼组（P < 0.05）。羟考酮组患者术后 2 h 静息及运动时疼痛 NRS 评分均低于芬太尼组（P <
0.05）。羟考酮组诱导期咳嗽反射的发生率显著低于芬太尼组（P < 0.05）。结论：羟考酮联合丙泊酚全凭静脉麻醉可安全用于
乳腺癌保乳手术，全麻诱导以及维持期间麻醉效果满意，术中对循环影响小，术后镇痛效果确切。
［关键词］ 羟考酮；丙泊酚；芬太尼；全凭静脉麻醉；乳腺癌；保乳手术
［中图分类号］ R614.2 ［文献标志码］ A ［文章编号］ 1007⁃4368（2023）12⁃1724⁃05
doi：10.7655/NYDXBNS20231217

Evaluation of clinical effects of combine use of oxycodone and propofol for total
intravenous anesthesia in breast⁃conserving surgery for breast cancer

1，2
1
1
WANG Yudong ，LIU Yuxian ，BIAN Qingming ，LIU Hui 1，2*
1 School of Anesthesiology，Xuzhou Medical University，Xuzhou 221002；Department of Anesthesiology，Jiangsu
2
Cancer Hospital，the Affiliated Cancer Hospital of Nanjing Medical University，Nanjing 210009，China
［Abstract］ Objective： To evaluate the effects of combined use of oxycodone and propofol for total intravenous anesthesia in patients
with breast cancer undergoing breast ⁃ conserving surgery，on the intraoperative anesthesia，perioperative adverse reactions and
analgesic effects. Methods：Eighty patients elective undergoing breast⁃conserving surgery for breast cancer，with American Society of
2
Anesthesiologists（ASA）physical status classification Ⅰ or Ⅱ，aged 26⁃61 year，and body mass index（BMI）of 19~28 kg/m ，were
randomly divided into oxycodone group（n=40）and fentanyl group（n=40）. The systolic blood pressure（SBP），diastolic blood pressure
（DBP），and heart rate（HR）were recorded at the following time points：before anesthesia induction（T0 ），immediately before tracheal
intubation（T1 ），at the start of surgery（T2 ），during resection of the breast specimen（T3 ），and at the end of surgery（T4 ）. The numerical
rating scale（NRS）for pain were recorded at rest and during movement at 2 h，6 h，24 h and 48 h after surgery. The time to awakening，
extubation time，and propofol consumption were also recorded. The incidence of cough reflex during induction，intraoperative
awareness，intraoperative hypotension，postoperative agitation，nausea and vomiting，and skin itching were observed in both groups.
Results：At T2 and T3，the SBP，DBP and HR in the oxycodone group were significantly higher than those in the fentanyl group（P <
0.05）. The NRS scores for resting pain and movement pain at 2 h after surgery were significantly lower in the oxycodone group than the
fentanyl group（P < 0.05）. The incidence of cough reflex during induction was significantly lower in the oxycodone group than in the

［基金项目］ 江苏省卫生健康委干部保健科研项目（BJ20028）
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通信作者（Corresponding author），E⁃mail： huilium@163.com