高玉峰^1,,
赵晓红²,
汤新^1,,
1. 大连大学附属中山医院 麻醉科, 辽宁 大连 116001
2. 上海市公共卫生临床中心 麻醉科, 上海 201508

详细信息 作者简介: 高玉峰(1972-), 男, 副主任医师。E-mail:904809995@qq.com



通讯作者: 汤新, 主任医师。E-mail:xtangqq@sina.com 中图分类号: R737.33


摘要:目的评价羟考酮在腹腔镜胆囊切除术（LC）中行喉罩全麻诱导的有效性、安全性以及对术后恢复质量的影响。方法收集择期行腹腔镜胆囊切除手术患者60例，年龄25~65岁，BMI 18~25 kg/m²，ASA分级Ⅰ或Ⅱ级，采用随机数字表法分为舒芬太尼组（S组）和羟考酮组（O组）（每组30例）。S组静脉注射舒芬太尼0.25 μg/kg、依托咪酯0.3 mg/kg、罗库溴铵0.6 mg/kg诱导喉罩置入术后行机械通气，O组静脉注射羟考酮0.25 mg/kg、依托咪酯0.3 mg/kg、罗库溴铵0.6 mg/kg诱导喉罩置入术后行机械通气；术中静脉泵注丙泊酚和瑞芬太尼维持麻醉。记录诱导前（T0）、插喉罩前（T1）、插喉罩后1 min（T2）、气腹（T3）和切胆囊时（T4）的MAP和HR；评估两组患者拔喉罩后5 min（T5），1 h（T6），4 h（T7），8 h（T8），12 h（T9）的疼痛视觉模拟量表评分（VAS）；记录手术时间、苏醒时间、拔喉罩时间、丙泊酚和瑞芬太尼的用量、术后肛门首次排气时间以及术中对降压药和术后对镇痛药的需求例数。记录两组患者不良反应的发生情况。结果两组MAP的变化趋势不同（P < 0.05），与T0时比较，S组T1，2时MAP降低（P < 0.05），T3，4时MAP升高（P < 0.05），O组T1，2，3，4时MAP均降低（P < 0.05），与S组比较，T3，4时O组MAP较低（P < 0.05）；T1，2，3，4时两组患者HR与T0时比较均降低（P < 0.05），但两组HR变化趋势无差异；两组患者静息和咳嗽时VAS评分的变化趋势均不同（P < 0.05），两种状态下O组VAS评分均低于S组（P < 0.05），并且O组术中降压药、术后镇痛药使用减少（P < 0.05），术后肛门排气时间缩短（P < 0.05）；恶心呕吐及呛咳减少（P < 0.05）。结论0.25 mg/kg羟考酮诱导行喉罩通气下腹腔镜胆囊切除手术安全有效，与等效剂量的舒芬太尼相比，有利于术中循环稳定和术后病人的转归。
关键词: 羟考酮/
舒芬太尼/
胆囊切除术/
腹腔镜


Abstract:ObjectiveTo evaluate the validity, safety and effects on postoperative recovery of oxycodone hydrochloride in the induction of laryngeal mask airway general anesthesia in patients undergoing laparoscopic cholecystectomy (LC).MethodsSixty adult patients were enrolled in the study, who were scheduled for elective LC, aged 25-65 years, with body mass index 18-25 kg/m² and American society of Anesthesiologists physical status Ⅰ or Ⅱ. The patients were randomly divided into 2 groups (n=30) using a random number table: sufentanil group (group S) and oxycodone hydrochloride group (group O). In group S, after anesthesia induction with iv sufentanil 0.25 μg/kg, etomidate 0.3 mg/kg and rocuronium 0.6 mg/kg, laryngeal mask was intubated for ventilation. The same procedures were performed in group O except that oxycodone hydrochloride 0.25 mg/kg replaced sufentanil and anesthesia was maintained with iv propofol and reminfentanil. The MAP and HR were compared with each other at different time points: entering the operating room (T0), before intubation (T1), one minute after intubation (T2), pneumoperitoneum (T3) and removal of the gallbladder (T4). Visual analogue scale (VAS) scores were evaluated at different time points: 5 min (T5), 1 h (T6), 4 h (T7), 8 h (T8) and 12 h (T9) after extubation. The time of operation, recovery from anesthesia and extubation and postoperative first anal exhaust, the consumptions of propofol and remifentanil were all recorded. The number of cases demanding hypotensive drugs during operation and analgesic after operation was also recorded. Severe adverse reactions in two groups were recorded.ResultsThe tendency of MAP changes was different in the two groups (P < 0.05). Compared with time point T0, MAP was lower in group S at T1, 2 (P < 0.05) and higher at T3, 4 (P < 0.05); whereas MAP was lower in group O at T1, 2, 3, 4 (P < 0.05). Compared with group S, MAP was lower in group O at time points T3, 4 (P < 0.05). HR was lower in both groups at time points T1, 2, 3, 4 compared with time point T0 (P < 0.05) although the tendency of HR changes in the two groups was similar. The variation tendency of VAS scores in two groups at both rest and cough was different (P < 0.05), either rest or cough the VAS scores was lower in group O than in group S (P < 0.05). In group O, the demanding of hypotensive drugs and anesthetics was less (P < 0.05), the time of postoperative first anal exhaust was shorter (P < 0.05), the incidence of nausea vomiting and bucking was less (P < 0.05).ConclusionCompared with the same dose of sufentanil, 0.25 mg/kg oxycodone hydrochloride in the induction of general anesthesia with laryngeal mask airway in LC is safe and efficient. It is beneficial for both intraoperative hemodynamic stability and postoperative outcome.
Keywords:oxycodone/
sufentanil/
cholecystectomy/
laparoscopes

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