盐酸羟考酮在颅内动脉瘤栓塞术麻醉中的应用

Clinical use of oxycodone in the embolization of intracranial aneurysms

目的探讨盐酸羟考酮应用于颅内动脉瘤栓塞术麻醉中的效果及其临床应用价值。方法 2014年9月至2016年9月在我院择期全麻下行颅内动脉瘤栓塞术的患者60例,性别不限,采用随机数字表法,分为2组(n=30):羟考酮组(O组):静脉给予依托咪酯0.3mg/kg、羟考酮0.3mg/kg和顺式阿曲库铵0.2mg/kg,芬太尼组(F组):静脉给予依托咪酯0.2mg/kg、芬太尼0.003mg/kg和顺式阿曲库铵0.2mg/kg。两组患者均在麻醉后3min置入I-gel喉罩,术中吸入2%~4%浓度七氟醚来维持血压(BP)和心率(HR)波动幅度不超过基础值的20%,BIS在40~60之间。记录两组患者在麻醉诱导前(T1)、插喉罩前(T2)、插喉罩后1 min(T3)、插喉罩后3min(T4)、放置弹簧圈时(T5)、放置弹簧圈后(T6)、术毕(T7)的HR,平均动脉压(MAP);记录手术时间、麻醉时间、苏醒时间和拔除喉罩时间;记录术后6h、24h和48h患者的VAS评分以及术后并发症的发生情况。结果两组患者在T3、T4、T5和T6时点的HR和MAP均有一定幅度下降,但F组患者下降幅度更明显(P<0.05)。O组患者的苏醒时间以及拔除喉罩时间均明显短于F组,差异有统计学意义(P<0.05)。O组患者术后6h的VAS评分明显低于F组,差异有统计学意义(P<0.05)。结论在颅内动脉瘤栓塞术麻醉中,盐酸羟考酮可安全有效地用于麻醉诱导,有利于缩短患者的苏醒时间,且可帮助神经外科医生早期进行神经功能的评估,同时可降低患者术后头痛的VAS评分,值得临床推广。

Objective To evaluate the effect and clinical application value of oxycodone in the embolization of intracranial aneurysms. Methods Sixty patients of both sexes, scheduled for elective embolization of intracranial aneurysms from September 2014 to June 2016, were randomly divided into 2 groups （n= 30 each） ： Oxycodone group （group O） ：Etomidate 0. 3 mg/kg, oxycodone 0. 3 mg/kg and cisatracurium 0. 2 mg/kg was injected intravenously for anesthesia induction. Fentanyl group （group F） ： Etomidate 0. 3mg/kg, fentanyl 0. 003 mg/kg and cisatracurium 0. 2 mg/kg was injected intravenously for anesthesia induction. Laryngeal mask airway（LMA） were inserted in both groups 30 minutes after anesthesia induction. Both groups were maintained with 2%-4% sevoflurane inhalation during the operation,to keep blood pressure（BP） and heart rate （HR） fluctuating in their respective basic values of q-20G ,BIS value in the range of 40-60. HR and Mean arterial pressure（MAP） were recorded before anesthesia induction（T1）, before the insertion of LMA（T2）, 1 minute after the insertion of LMA（T3）, 3 minutes after the insertion of LMA（T4）, coils deployed to fill the aneurysm（T5）,after the coil embolization（T6）,after the operation（T7）. Operation time, anesthesia time, recovery time and extubation time were recorded. At 6.24.48h after operation, scores of numeric rating scale （NRS） and complications were recorded. Results Both HR and MAP were decreased in 2 groups at T3, T4, T5, T6, compared with group O, HR and MAP were lower in group F（P〈0.05）. Compared with group F, recovery time and extubation time was shorter in-group O （P〈0.05）. Compared with group F, VAS scores （6h after the operation） were lower in-group O （P%0. 05）. Conclusion Oxycodone can be safely and effectively used in anesthesia induction for the embolization of intracranial aneurysms, leading to less recovery time , extubation time and lower VAS scores of headache after operation. It＇s helpful to evaluate the neurological function for neurosurgeons and valuable for a wide clinical application.