性别因素对羟考酮抑制老年患者眼科手术喉罩置入反应有效剂量的影响

Effect of gender factor on the effective dose of oxycodone for inhibiting responses to laryngeal mask airway insertion in elderly patients undergoing ophthalmic surgery

目的评价性别因素对羟考酮抑制老年患者眼科手术喉罩置入反应有效剂量的影响。方法选择2021年6至10月首都医科大学附属北京同仁医院择期行喉罩全身麻醉眼科手术患者56例,其中女26例,男30例,年龄65~80(72±5)岁,体质指数(BMI)18.5~24.9 kg/m^(2),美国麻醉医师协会(ASA)分级Ⅰ或Ⅱ级。根据性别分为老年女性组和老年男性组。采用改良Dixon序贯法进行研究,首例患者静脉注射羟考酮0.10 mg/kg,5 min后,静脉注射依托咪酯0.2 mg/kg和顺式阿曲库铵0.1 mg/kg,3 min后,脑电双频指数(BIS)≤60时置入喉罩。喉罩置入反应阳性标准:喉罩置入后2 min内平均动脉压最大值(MAPmax)或心率最大值(HRmax)的升高幅度超过基础值的20%。若喉罩置入反应阳性,则下1例患者羟考酮的用量增加1个阶梯剂量,否则降低1个阶梯剂量,相邻剂量比值为1.1,重复此过程,直到出现7个转折点。分别计算并比较两组患者应用羟考酮抑制喉罩置入反应的半数有效剂量(ED50)及95%CI。同时观察麻醉诱导过程中不良反应发生情况。结果老年女性组26例患者均完成试验,老年男性组有1例患者因喉罩对位不良未完成试验,最终29例患者完成试验。老年女性组患者中,13例出现喉罩置入阳性反应;老年男性组患者中,14例出现阳性反应。老年男性组羟考酮抑制喉罩置入反应的ED50(95%CI)为0.096(0.083~0.112)mg/kg,高于老年女性组的0.081(0.073~0.098)mg/kg(P=0.008)。55例患者均未出现呛咳、肌震颤、低氧血症以及恶心、呕吐、反流误吸等不良反应。老年女性组有1例患者出现诱导后一过性低血压,对症处理后好转。结论不同性别患者应用羟考酮抑制眼科手术喉罩置入反应的ED50不同,在老年男性组为0.096(0.083~0.112)mg/kg,在老年女性组为0.081(0.073~0.098)mg/kg。

Objective To evaluate the effect of gender factor on the effective dose of oxycodone for inhibiting responses to laryngeal mask airway(LMA)insertion in elderly patients undergoing ophthalmic surgery.Methods From June to October 2021,56 elderly patients,including 26 females and 30 males,aged from 65 to 80(72±5)years,with a body mass index(BMI)of 18.5-24.9 kg/m^(2) and American Society of Anesthesiologists(ASA)physical status ofⅠorⅡ,who underwent elective ophthalmic surgery requiring LMA insertion in the Beijing Tongren Hospital affiliated to Capital Medical University were selected.Patients were divided into two groups according to gender:elderly female group and elderly male group.The modified Dixon sequential method was used.Oxycodone 0.10 mg/kg was injected intravenously in the first patient.Etomidate 0.2 mg/kg and cisatracurium 0.1 mg/kg were administrated 5 min later.After 3 min,the laryngeal mask was placed when the bispectral index(BIS)≤60.The positive response to LMA insertion was defined as an increase in the maximum mean arterial pressure or the maximum heart rate>20%of the baseline value within 2 min after insertion.When the response to LMA insertion was positive,the dose of oxycodone was increased in the next patient,otherwise the dose was decreased,and the ratio of adjacent dose was 1.1.This process was repeated until the 7th turning point occurred.The half-maximal effective doses(ED50)and 95%confidence intervals(CI)of oxycodone for inhibiting laryngeal mask insertion were calculated and compared between the two groups.Meanwhile,the adverse reactions during anesthesia induction were observed.Results All 26 patients in the elderly female group completed the test,but one patient in the elderly male group withdrew due to poor alignment of laryngeal mask,and finally 29 patients completed the study.There were 13 cases and 14 cases who had positive response to LMA insertion in the elderly female and male groups,respectively.The ED50(95%CI)of oxycodone for inhibiting laryngeal mask insertion in the elderly male group was 0.096(0.083-0.112)mg/kg,which was higher than that in the elderly female group[0.081(0.073-0.098)mg/kg,P=0.008].No adverse reactions such as choking cough,muscle tremor,hypoxemia,nausea,vomiting,reflux and aspiration occurred in 55 patients,except that one patient in the elderly female group had transient hypotension after induction,which improved after symptomatic treatment.Conclusion The ED50 of oxycodone for inhibiting laryngeal mask insertion reaction in ophthalmic surgery is different in patients with different genders,which is 0.096(0.083-0.112)mg/kg in the elderly male group and 0.081(0.073-0.098)mg/kg in the elderly female group.