羟考酮用于老年患者腹腔镜胆囊切除术麻醉的可行性研究

Feasibility of Oxycodone Anesthesia in Elderly Patients Undergoing Laparoscopic Cholecystectomy

目的探讨盐酸羟考酮麻醉诱导用于老年患者胆囊手术的可行性。方法择期腹腔镜下胆囊切除术老年患者60例,年龄65~80岁,ASA分级Ⅰ~Ⅲ级。采用数字表法随机分为盐酸羟考酮诱导组(O组)和舒芬太尼诱导组(S组),每组各30例。O组盐酸羟考酮诱导剂量为0.3mg/kg,S组舒芬太尼为0.3μg/kg,给药5 min后进行气管插管,其余诱导药物相同。于诱导前(T_0)、气管导管进入声门(T_1)、插管后1、3和5min(T_(2、3、4))采动脉血,测定血浆肾上腺素、去甲肾上腺素和皮质醇浓度;并记录相应时间点平均动脉压(MAP)和心率(HR)。术毕复苏室观察拔除气管导管5、10、15、30min呼吸状态改变、呼吸抑制发生率和疼痛评分。结果两组间各时点MAP和HR比较差异无统计学意义(P>0.05)。与T_0比较,O组和S组T_3和T_4时点血肾上腺素和去甲肾上腺素浓度均显著下降(P<0.05),而两组间各时点差异无统计意义(P>0.05)。与S组比较,O组拔管后5和10min呼吸频率较快(P<0.05),呼吸异常和SpO_2≤90%发生率显著降低(P<0.05,P<0.01);O组拔管后5、10和15min视觉模拟评分较S组显著下降。结论盐酸羟考酮可安全有效用于老年患者短小手术的麻醉诱导,能降低拔管后早期呼吸抑制的发生率。

Objective To study the feasibiltiy of oxycodone hydrochloride for anesthesia induction in elderly patients after laparoscopic cholecystectomy. Methods Sixty ASA physical status Ⅰ to Ⅲ elderly obese patients, aged 65-80 year, scheduled for elective laparoscopic cholecystectomy were randomly allocated into 2 groups（n=30 each）：oxycodone group （group O） and sufentanil group（group S）.Anesthetic induction dose of 0.3mg/kg oxycodone in group O and 0.3μg/kg sufentanil in group S, when 5 minutes elapsed endotracheal intubation was initiated in both groups. Hemodynamic parameters of mean arterial pressure（MAP） and heart rate（HR） were recorded. Arterial blood sample was extracted for assaying the concentrations of plasma adrenaline, noradrenaline and cortisol at the following time points：before induction（T0）, tube entering glottis（T1） and at 1,3 and 5min after intubation（T2,3,4）. In postanesthesia care unit, the ventilation status, mild hypoxia were observed within 30 minutes after extubation. Visual analogue score was assessed every 5 minutes after extubation. Results There were no statistical significances about MAP and HR in different time points between the two groups. When compared to T0, plasma concentration of adrenaline and noradrenaline in T3 and T4 markedly decreased（P〈0.05）, whereas no differencs were found between the two groups（P〉0.05）. In comparison with group S, group O had lower incidence of abnormal ventilation status and occurrence of SpO2 below 90% in 5min and 10min after extubation. Moreover, visual analog scale of group O in 5,10 and 15min after extubation significantly reduced compared to them in group S. Conclusion Oxycodone hydrochloride is safe and effectiye in anesthesia induction for elderly patients performing laparoscopic cholecystectomy, which is associated with a lower incidence of early postoperative respiration depression.