盐酸羟考酮和舒芬太尼对神经外科手术全身麻醉患者苏醒质量的影响比较

Comparison of Effects of Oxycodone Hydrochloride and Sufentanil on Anesthesia Recovery in Neurosurgical Operation

目的观察在神经外科手术中舒芬太尼或盐酸羟考酮对全身麻醉患者苏醒质量的影响。方法择期在全身麻醉下行经乙状窦入路显微血管减压术患者120例,随机分为4组,分别为羟考酮0.03 mg·kg^(-1) 组(H1组)、羟考酮0.05 mg·kg^(-1) 组(H2组)、羟考酮0.08 mg·kg^(-1) 组(H3组)、舒芬太尼0.08μg·kg^(-1) 组(S组),各30例。全身麻醉诱导后瑞芬太尼4 ng·m L^(-1) 靶控输注,丙泊酚5~6 mg·kg^(-1) ·h^(-1) 泵注维持麻醉,使脑电双频指数(BIS)维持在40~60。开始缝合硬脑膜时,按照不同剂量给予舒芬太尼或盐酸羟考酮静脉滴注。记录4组患者手术结束时BIS值,丙泊酚总量,麻醉维持时间,手术持续时间,给药至手术结束时间,手术结束至自主呼吸恢复时间、清醒时间及拔管时间,手术结束后10,20,30 min时患者镇痛口述分级评分(VRS)和镇静评分(SS)及不良反应。结果 4组患者术后10 min时VRS评分差异无统计学意义。术后20,30 min时H1组评分均高于H2组、H3组。4组患者术后10 min时SS评分差异无统计学意义,术后20 min时H1组评分低于H3组,S组评分低于H2组、H3组,术后30 min时H3组评分高于H1组、H2组、S组。结论神经外科手术中给予舒芬太尼0.08μg·kg^(-1) 或盐酸羟考酮0.05 mg·kg^(-1) 均可以获得良好的麻醉苏醒质量。

Objective To observe the recovery efficiency of sufentanil and oxycodone hydrochloride in neurosurgical operation.Methods Total of 120 patients scheduled for microvascular decompression under general anesthesia were randomly divided into 4 groups to receive 0.03 mg·kg-1 oxycodone （group H1）, 0.05 mg·kg-1 oxycodone （group H2）, 0.08 mg·kg-1 oxycodone （group H3）, and 0.08 μg·kg-1 sufentanil （group S）.Each patient accepted 4 ng·mL-1 of remifentanil and 5-6 mg·kg-1·h-1 of propofol after induction to maintain bispectral index （BIS） value at 40-60.On starting to suture dura mater, oxycodone or sufentanil was given in various doses through intravenous route.The BIS value, the amount consumption of propofol, anesthesia and operation duration, and the drug delivery time of each group were recorded.The time of spontaneous breath recovery, awaking and extubation, verbal rating score （VRS） and sedation score （SS） at 10 min, 20 min, 30 min after operation as well as side-effects were also recorded.Results The VRS scores had no statistic difference among the groups at 10 min after operation, while the average scores of H1 were higher than those of H2 and H3 at 20, 30 min after operation.No statistic difference of the SS scores was showed among 4 groups at 10 min after operation, but it was lower in group H1 than those in group H3, and lower in group S than those in H2 at 20 min after operation;group H3 had a significantly higher SS scores than H1, H2 and S at 30 min after operation.Conclusion Oycodone hydrochloride 0.05 mg·kg-1 or sufentanil 0.08 μg·kg-1 can both provide satisfactory recovery quality in neurosurgical operation.