羟考酮与舒芬太尼用于面神经微血管减压术患者麻醉效果的比较

A comparison of anesthetic effects of oxycodone and sufentanil in patients undergoing microvascular decompression surgery for hemifacial spasm

目的评价羟考酮与舒芬太尼用于面神经微血管减压术患者的麻醉效果。方法选择2019年8月至2020年1月首都医科大学宣武医院择期行面神经微血管减压术的患者60例,随机分为舒芬太尼组(S组,31例)和羟考酮组(O组,29例)。麻醉诱导采用静脉注射舒芬太尼0.2μg/kg(S组)或羟考酮0.2 mg/kg(O组),依托咪酯0.2 mg/kg和顺苯磺酸阿曲库铵0.15 mg/kg。麻醉维持均持续泵注丙泊酚和瑞芬太尼。闭合硬脑膜时,静脉注射舒芬太尼0.05μg/kg(S组)或羟考酮0.05 mg/kg(O组)。术毕均行患者自控静脉镇痛(patient controlled intravenous analgesia, PCIA)。记录两组麻醉诱导前(T0),气管插管前即刻(T1),气管插管后即刻(T2),切皮时(T3),钻孔时(T4),放置垫片时(T5),手术结束即刻(T6),气管拔管后即刻(T7)、1 min(T8)、5 min(T9),手术结束后30 min(T10)、1 h(T11)、2 h(T12)、4 h(T13)和6 h(T14)的HR及MAP。记录两组苏醒时间、拔管时间、术后疼痛视觉模拟评分(visual analogue score, VAS)和不良反应发生情况。结果与T1时点比较,S组T2时点HR升高(P<0.05),MAP似乎有升高但差异无统计学意义(P=0.056);O组T2时点HR及MAP无明显变化(P>0.05)。在T7和T8时点,S组HR高于O组(P<0.05),但MAP的差异无统计学意义(P>0.05)。除T7和T8时点外,余各时点两组间HR及MAP差异无统计学意义(P>0.05)。两组术中均无体动反应发生,O组和S组麻醉苏醒时间[7.0(6.0, 8.0)min比7.0(5.0, 8.3)min, P>0.05]和拔管时间[8.0(8.0, 10.8)min比8.0(6.0, 10.3)min, P> 0.05]差异无统计学意义。O组术后1 h的VAS[1.0(0.0, 1.4)分比2.0(1.0, 3.8)分, P<0.05]及术后1 h内需行PCIA单次按压的人数比例(6.9%比41.9%,P<0.05)均低于S组。两组术后1 h内恶心呕吐、头晕、术后寒战发生率比较,差异无统计学意义(P>0.05),所有患者均未发生术后躁动、皮肤瘙痒、呼吸抑制和过度镇静。结论羟考酮与等效剂量的舒芬太尼用于面神经微血管减压术患者麻醉效果比较,羟考酮组围术期血流动力学更平稳,术后镇痛效果更好,不影响术后苏醒和拔管,不增加术后不良反应。

Objective To compare the anesthetic effects of oxycodone and sufentanil in the patients undergoing microvascular decompression surgery for hemifacial spasm. Methods A total of sixty patients undergoing microvascular decompression surgery for hemifacial spasm were randomly divided into sufentanil group(group S, n = 31) and oxycodone group(group O, n = 29). Anesthesia induction was conducted by intravenous injection of 0.2 μ g/kg of sufentanil(group S) or0.2 mg/kg of oxycodone(group O), 0.2 mg/kg of etomidate and 0.15 mg/kg of cisatracurium besylate. Anesthesia was maintained by the continuous infusion of propofol and remifentanil. At the time of dural closure, 0.05 μ g/kg of sufentanil(group S)or 0.05 mg/kg of oxycodone(group O) was injected intravenously. When the surgery was completed, the patient controlled analgesia pump was connected. HR and MAP were recorded prior to anesthesia induction(T0), immediately before endotracheal intubation(T1), immediately after endotracheal intubation(T2), at the start of surgery(T3) and trepanation(T4), at the time of placing the teflon felt(T5), at the end of operation(T6), immediately after extubation(T7), at 1 min(T8) and 5 min(T9) after extubation, at 30 min(T10), 1 h(T11), 2 h(T12), 4 h(T13) and 6 h(T14) after operation. Moreover, the awakening time, extubation time, postoperative pain score and adverse events were recorded as well. Results Compared with T1, HR at T2 in group S increased(P<0.05), while MAP appeared to have increased but with no significant difference(P = 0.056). When compared with T1, there was no significant difference of HR and MAP at T2 in group O(P>0.05). At the time points of T7 and T8, HR was higher in group S than in group O(P<0.05), and no statistical difference in MAP was observed between the two groups(P>0.05). Except for T7 and T8, there were no significant differences spotted in HR and MAP between the two groups(P>0.05). There was no body motion response observed in the two groups during the operation, and no significant differences were found in the awakening time [7.0(6.0, 8.0)min vs. 7.0(5.0, 8.3)min, P>0.05] and extubation time [8.0(8.0, 10.8)min vs. 8.0(6.0, 10.3)min, P>0.05] between group O and group S. In comparison with group S, VAS at 1 h after operation [1.0(0.0,1.4) vs. 2.0(1.0, 3.8), P<0.05] and the proportion of patients needing a single compression for patient controlled analgesia within 1 h of operation(6.9% vs. 41.9%, P<0.05) were lower in group O. There were no significant differences observed in the incidence of adverse events within 1 h of operation between the two groups(P>0.05). Conclusions Oxycodone is judged as effective and suitable for anesthesia in the patients undergoing microvascular decompression surgery for hemifacial spasm.