羟考酮复合丙泊酚预防宫腔镜手术中寒战及宫缩痛效果研究

Oxycodone compound propofol in hysteroscopic surgery and its preventive efficacy on chills and uterine contraction pain

目的探讨羟考酮在宫腔镜手术中的麻醉效果及对寒战、宫缩痛的预防效果。方法将鞍钢集团公司总医院2015年7月至2017年4月收治的行宫腔镜手术患者135例根据随机数字分为对照组、研究1组、研究2组,每组45例。对照组采用1μg/kg瑞芬太尼复合2mg/kg丙泊酚注射液实施麻醉诱导,研究1组、2组分别于丙泊酚麻醉诱导前3min静脉注射0.1 mg/kg与0.15mg/kg羟考酮注射液。各组均泵注1mg/(kg·h)丙泊酚麻醉维持,如患者术中明显体动,则静脉追加0.5mg/kg丙泊酚,记录并比较3组麻醉效果、不同时点麻醉后生命体征变化及围术期寒战、术中呼吸抑制、术后宫缩痛等不良反应。结果研究1组、2组麻醉起效时间[(32.54±4.72)s、(30.65±4.38)s]、术后苏醒时间[(5.15±1.55)min、(6.30±1.78)min]、丙泊酚用量[(2.93±0.67)mg/kg、(2.72±0.60)mg/kg]显著少于对照组[(36.25±5.33)s、(8.21±3.02)min、(3.80±0.82)mg/kg](P<0.05),研究2组术后苏醒时间显著长于研究1组,术中丙泊酚用量显著少于研究1组(P<0.05)。研究2组丙泊酚麻醉诱导后脉搏血氧饱和度(SpO_2)为0.929±0.037、心率为(63.5±5.5)次/min,显著低于对照组的0.958±0.030、(67.5±6.2)次/min(P<0.05),SpO_2亦显著低于研究1组的0.950±0.027(P<0.05)。研究1组、2组术中体动发生率、围术期寒战发生率及严重程度评分、术后1h与4h宫缩痛评分均显著低于对照组(P<0.05)。结论宫腔镜术前采用羟考酮复合丙泊酚麻醉能减少术中丙泊酚用量,减少围术期寒战、术后宫缩痛等不良反应,0.1mg/kg羟考酮总体效果优于0.15mg/kg。

Objective To observe the anesthetic efficacy of oxycodone in hysteroscopic surgery and its preventive effica- cy on chills and uterine contraction pain.Methods A total of 135 patients who received hysteroscopic surgery from July 2015 to April 2017 were selected and randomly divided into control group and test group 1 and test group 2 according to random number, each group with 45 cases. The control group received anesthesia induction with injection of 1g/kg remi- fentanil plus 2mg/kg propofol;test group 1 and 2 were injected with 0.1 mg/kg and 0.15mg/kg oxycodone intravenously 3 min before propofol anesthesia induction, respectively. Then all 3 groups were infused with lmg/（kg·h）propofol to main- tain anesthesia. In case of apparent physical movement, additional 0.5mg/kg propofol was added. The anesthesia efficacy, variations of vital signs at different time points after anesthesia, perioperative chills, intraoperative respiratory depres- sion, postoperative uterine pain and other adverse reactions of the 3 groups were recorded and compared.Results The anesthesia onset time [ （32.54±4.72）s, （30.65±4.38）s], recovery time [ （5.15±1.55）min, （6.30±1.78）min] and propo- fol dosage [ （2.93±0.67）mg/kg, （2.72±0.60）mg/kg] in test group 1 and 2 were significantly less than those in the control group [ （36.25±5.33）s, （8.21±3.02）min, （3.80±0.82）mg/kg] （P〈0.05） ;the postoperative recovery time in test group 2 was significantly longer than that in test group 1, and the intraoperative propofol dosage in test group 2 was significantly lower than that in test group 1 （P〈0.05）. The SPO2（0.929±0.037）, and HR（63.5±5.5）bpm after anesthesia induction in test group 2 were significantly lower than those in the control group [ （0.958±0.030）, （67.5±6.2）bpm] （P〈0.05）, and the SpO2 in test group 2 was also significantly lower than that in the test group 1 （0.950±0.027） （P〈0.05）. The physical move-ment, perioperative incidence of chills and severity score, contraction pain scores （1h and 4h after operation）in test group 1 and test group 2 were significantly lower than those in the control group （P〈0.05）.Conclusion Preoperative an-esthesia with oxycodone compound propofol in hysteroscopy can reduce intraoperative propofol dosage and alleviate peri- operative chills, postoperative uterine pain and other adverse reactions. The overall efficaey of 0.1 mg/kg oxycodone is better than 0.15mg/kg.