不同剂量羟考酮复合异丙酚和瑞芬太尼用于宫腔镜手术患者的麻醉效果

Effects of different doses of oxycodone combined with propofol and remifentanil on the patients undergoing hysteroscopy surgery

目的评价宫腔镜手术患者使用不同剂量羟考酮复合异丙酚和瑞芬太尼麻醉的效果。方法选取择期宫腔镜手术患者300例,年龄18~60岁,BMI18~24kg/m^2,ASA分级Ⅰ或Ⅱ级。采用随机数字表法将患者分为5组(n=60):瑞芬太尼(R组)、舒芬太尼组(S组)和羟考酮0.05、0.10、0.15mg/kg组(O1-3组)。麻醉诱导:O1-3组静脉注射相应剂量羟考酮,R组和S组分别静脉注射瑞芬太尼1μg/kg和舒芬太尼0.5μg/kg,随后均静脉注射异丙酚2mg/kg和琥珀胆碱1mg/kg,置入喉罩后行机械通气。麻醉维持:静脉输注异丙酚6~12mgkg^-1h^-1和瑞芬太尼0.25μgkg^-1min^-1。记录麻醉诱导时咳嗽发生情况、术中体动、心血管事件的发生情况和苏醒时间;术后VAS评分≥4分时,静脉注射氟比洛芬酯50mg,记录术后恶心及呕吐的发生情况。结果与R组和S组比较,O1-3组术中低血压、心动过缓的发生率、术后氟比洛芬酯使用率、恶心和呕吐的发生率均降低(P均<0.05);与R组比较,其他4组苏醒时间缩短,O2组和O3组高血压和心动过速的发生率降低(P<0.05);与S组比较,O1-3组诱导时咳嗽发生率降低(P<0.05),O1组高血压和心动过速发生率升高(P<0.05);与O1组比较,其他4组术中体动发生率降低,异丙酚用量减少,O2组和O3组高血压和心动过速的发生率降低,术后氟比洛芬酯使用率降低,O3组心动过缓发生率升高(P<0.05)。结论宫腔镜手术患者使用羟考酮0.10~0.15mg/kg复合异丙酚和瑞芬太尼的麻醉效果确切,苏醒迅速,术后镇痛效果好,麻醉恢复期不良反应少。

Objective To observe the clinical effects of different doses of oxycodone combined with propofol and remifentanil on the patients undergoing hysteroscopy surgery. Methods Three hundred patients,aged between 18 to 60,with body mass index (BMI) of 18-24 kg/m^2,of ASA physical status Ⅰ or Ⅱ were enrolled in the study and randomly divided into 5 groups by a random number table ( n =60).Remifentanil of 1 μg/kg (group R),sufentanil of 0.5 μg/kg (group S) and oxycodone of 0.05,0.10,0.15 mg/kg combined with propofol and remifentanil (group O1-3 ) was infused by vein,respectively.All patients in each group were induced under general anesthesia by vein injection of oxycodone,remifentanil or sufentanil followed by 2 mg/kg of propofol infusion.Succinylcholine of 1 mg/kg was administered for muscle relaxation prior to intubation.All patients were mechanically ventilated after intubation with the laryngeal mask.Anesthesia was maintained with infusion at the rate of 6-12 mg kg^-1 h^-1 for propofol and remifentanil 0.25 μg kg^-1 min^-1.Then we observed and recorded the occurrence of cough,hypertension,bradycardia,tachycardia,body movement and cardiovascular events,respectively.Flurbiprofen 50 mg was administrated when the VAS score was 4 grade and above,and the incidence of nausea and vomiting were recorded. Results Compared with group R and S,the incidence of hypotension,bradycardia,nausea and vomiting,and the usage of flurbiprofen significantly decreased in group O 1-3 ( P <0.05).Compared with group R,the incidence of hypertension and tachycardia significantly decreased in group O1,and postanaesthetic recovery time significantly decreased in the other 4 groups ( P <0.05).Compared with group S,the incidence of cough significantly decreased in group O1-3 ( P <0.05),the incidence of hypertension and tachycardia significantly increased in group O1 ( P <0.05).Compared with group O1,the incidence of hypertension and tachycardia and the usage of flurbiprofen significantly decreased in group O2 and O3 ( P <0.05),the incidence of bradycardia significantly increased in group O3,and the incidence of body movement and propofol dosage significantly decreased in the other 4 groups. Conclusions Oxycodone of 0.10-0.15 mg/kg combined with propofol and remifentanil can be safely and effectively used in hysteroscopy surgery as an alternative anesthesia method,which characterized by rapid recovery from anesthesia and ideal postoperative analgesia with mild adverse effects.