不同剂量羟考酮复合丙泊酚用于宫腔镜手术麻醉效果比较

The anesthesia effects of different doses of oxycodone combined with propofol in patients underwenting hysteroscopy

目的观察不同剂量羟考酮复合丙泊酚用于宫腔镜手术的麻醉效果。方法选择行宫腔镜手术患者120例,随机分为4组(n=30):丙泊酚2 mg/kg组(P组)、丙泊酚复合羟考酮0.06 mg/kg组(Q1组),丙泊酚复合羟考酮0.09 mg/kg组(Q2组),丙泊酚复合羟考酮0.12 mg/kg(Q3组)。Q1组、Q2组、Q3组和P组分别于手术开始前缓慢静脉注入羟考酮0.06、0.09、0.12 mg/kg和等容积0.9%氯化钠溶液,药物术前均稀释成10 ml,注射时间大于1 min。药物注射完毕3 min后缓慢静脉注射丙泊酚2 mg/kg。观察患者给药前、意识消失、宫颈扩张以及术毕各时间点的平均动脉压(MAP)、心率(HR)变化,术中丙泊酚用量、发生呼吸抑制的例数和术后意识恢复时间、不良反应。记录清醒即刻(T0)、清醒后15 min(T1)、30 min(T2)、60 min(T3)的Prince-Henry评分。结果与基础状态的MAP比较,P组患者在意识消失时MAP明显降低(P<0.05),宫颈扩张时MAP明显升高(P<0.05),Q1组患者宫颈扩张时MAP明显升高(P<0.05);Q2组和Q3组术中丙泊酚用量明显低于P组(P<0.05),且Q1和Q2组患者呼吸抑制发生率明显低于P组(P<0.05);与P组比较,Q1、Q2和Q3组患者在术后不同时间点Prince-Henry评分>2分例数明显降低(P<0.05或<0.01);P组术后患者躁动发生率明显高于Q2组和Q3组(P<0.05),而Q3组术后头痛发生率明显高于P组(P<0.05)、Q1组(P<0.05)和Q2组(P<0.05)。结论不同剂量羟考酮复合丙泊酚用于宫腔镜手术,可以减少丙泊酚用量,降低呼吸抑制发生率,改善患者的疼痛评分;0.09 mg/kg羟考酮复合丙泊酚具有较好的临床应用价值。

Objective To observe the anesthesia effects of different doses of oxycodone combined with propofol in patients underwenting hysteroscopy.Methods One hundred and twenty patients who would receive hysteroscopy were randomly divided into four groups,with 30 patients in each group.The patients in group P were treated by 2mg/kg propofol,the patients in group Q1 were treated by propofol with oxycodone 0.06mg/kg,the patients in group Q2 were treated by propofol with oxycodone 0.09mg/kg and the patients in group Q3 were treated by propofol with oxycodone 0.12mg/kg .The patients in group Q1,group Q2,group Q3 and group P were given oxycodone 0.06,0.09,0.12mg and same volume 0.9% sodium chloride solution,respectively by slow intravenous injection before operation.The preoperative drugs were diluted to 10ml,and injection time was more than 1min.On 3min after injection of the drugs,propofol 2mg was injected intravenously.The mean arterial pressure （MAP） and heart rate （HR） were recorded,respectively,at the time of unconsciousness,cervix relaxation and in different time points after hysteroscopy.The consumption of propofol,the incidence rate of respiratory depression,consciousness recovery time after operation and adverse reactions were observed,moreover,the Prince-Henry scores were evaluated at the time of 0 min （T1）,15min （T1）,30min （T2） and 60min （T3） after revival.Results As compared with MAP in basic state,the MAP [（65.2 ±9.5）mm Hg] in unconsciousness in group P was significantly decaresed （P〈0.05）,however the MAP [（88.4 ±11.3）mm Hg] in cervix relaxation was significantly increased in group P and group Q1 （P〈0.05）.The consumption of propofol [（180 ±12）mg] in group P was significantly higher than that in group Q2 [（149 ±12）mg] and group Q3 [（146 ±11）mg] （P〈0.05）,but the consumption of propofol in group Q2 and group Q3 during operation was significantly lower than that in group P （P〈0.05）,moreover,the incidence rate of respiratory depression in group Q2 and group Q3 was significantly lower than that in group P （P〈0.05）.As compared with those in group P,the Prince-Henry scores （〉2 points） in group Q1,group Q2,group Q3 were significantly decreased （P〈0.05 or P〈0.01）,The incidence rate of dysphoria in group P （13.3%） was significantly higher than that in group Q2 （3.3%） and group Q3 （3.3%） （P〈0.05）.However the incidence rate of headache in group Q3 after operation was significantly higher than that in group P group,group Q1 and group Q2 （P〈0.05）.Conclusion The different doses of oxycodone combined with propofol in hysteroscopy surgery can decrease dosage of propofol,reduce the incidence rate of respiratory depression,improve patient＇ s pain score.Moreover oxycodone combined with propofol at dose of 0.09mg/kg has better clinical application value.