诱导期使用羟考酮对老年经尿道前列腺绿激光汽化术患者麻醉效果的影响

Effect of oxycodone in the induction period of anesthesia in the elderly patients undergoing transurethral green laser vaporization of prostate

目的观察喉罩全麻下老年经尿道前列腺绿激光汽化术诱导期使用羟考酮对麻醉效果的影响。方法本研究选择经尿道前列腺绿激光汽化术的老年男性患者60例,年龄65~80岁,ASAⅡ或Ⅲ级,采用随机数字表法分为羟考酮组(O组)和舒芬太尼组(S组),每组30例。O组全麻诱导期给予羟考酮0.15 mg/kg,S组全麻诱导期给予舒芬太尼0.15μg/kg。记录两组入手术室时、插入喉罩时和拔除喉罩时HR和MAP。记录两组术后2 h内导尿管相关膀胱刺激征(CRBD)的发生例数和程度。记录两组拔除喉罩即刻、拔除喉罩后1 h和拔除喉罩后2 h的VAS评分和躁动评分。记录两组术后恶心呕吐、呼吸抑制等不良反应发生情况。记录两组患者和外科医师对此次麻醉的满意度。结果 O组和S组入手室术时、插入喉罩时和拔除喉罩时HR和MAP差异无统计学意义。术后2h内O组CRBD发生11例(37%),明显少于S组24例(80%)(P<0.05)。术后2h内O组中重度CRBD发生率明显低于S组(P<0.05)。不同时点两组间VAS评分差异无统计学意义。O组拔除喉罩即刻和拔除喉罩后1 h躁动评分明显低于S组(P<0.05)。O组恶心呕吐和呼吸抑制发生率低于S组,但差异无统计学意义。O组患者满意度明显高于S组(P<0.05)。两组医师满意度差异无统计学意义。结论老年经尿道前列腺绿激光汽化术喉罩全麻诱导期使用羟考酮,具有围术期血流动力学稳定,有效防止术后导尿管相关膀胱刺激征和躁动发生,恶心呕吐、呼吸抑制并发症发生率低,患者及手术医师满意度高的优点。

Objective To observe the effect of oxycodone in the induction period of anesthesia of transurethral green laser vaporization of prostate in the elderly under laryngeal mask general anesthesia. Methods Sixty elderly male patients underwent transurethral prostate green laser vaporization were selected, aged 65-80 years, falling into ASA physical status Ⅱ or Ⅲ. All the patients were randomly divided into oxycodone group(group O) and sufentanil group(group S), thirty cases in each group. Group O was given 0.15 mg/kg oxycodone during induction of general anesthesia, group S was given 0.15 μg/kg sufentanil during induction of general anesthesia. HR and MAP were recorded when entering into the operating room, inserting laryngeal mask and removing laryngeal mask in both groups. The occurrence and severity of CRBD within 2 h after surgery were recorded. The VAS score and agitation score was recorded at instantly, 1 and 2 h after removing laryngeal mask. PONV and respiratory depression were observed in both groups. The satisfaction of patients and surgeons to the anaesthesia was recorded. ResultsThere was no significant difference in the heart rate and mean arterial pressure at the time of entering into the operating room, inserting laryngeal mask and removing laryngeal mask between group O and group S. Eleven cases(37%) of CRBD were occurred in group O, less than 24 cases(80%) in group S(P<0.05). Compared with the group S, severity of CRBD within 2 h after surgery in group O were apparently lower(P<0.05). There was no significant difference in VAS between the two groups at different time points. Compared with the group S, the agitation score at instantly and 1 h after removing laryngeal mask was inferior in group O(P<0.05). The incidence of PONV and respiratory depression in group O were lower than that in group S, but there were no significantly difference between two groups. The satisfaction of patients in group O was higher than that in group S(P<0.05). There was no significant difference in physician satisfaction between the two groups. Conclusion The use of oxycodone in the induction period of general anesthesia of laryngeal mask in the elderly patients undergoing transurethral green laser vaporization of prostate, which has the advantages of stable hemodynamics in the perioperative period, effective prevention of postoperative CRBD and agitation, low incidence of PONV and respiratory depression, and high satisfaction of patients and surgeons.