盐酸羟考酮与芬太尼在肝癌射频治疗全身麻醉中的对比

Oxycodone hydrochloride with fentanyl in general anesthesia in radiofrequency treatment of liver cancer

目的:探讨盐酸羟考酮与芬太尼在门诊日间手术室肝癌射频治疗全身麻醉中的麻醉效果及安全性。方法:选择择期行肝癌射频治疗手术患者80例,美国麻醉医生协会(ASA)Ⅰ-Ⅲ级,随机分为A、B两组。A组给予盐酸羟考酮联合丙泊酚和右美托咪啶(非气管插管)静脉全身麻醉;B组给予芬太尼联合丙泊酚和右美托咪啶(非气管插管)静脉全身麻醉。监测并记录入室(T0)、定位及开始泵注药物后5min(T1)、射频开始时(T2)、射频开始6min(T3)、射频结束时(T4)各时间点的平均动脉压(MAP)、心率(HR)、血氧饱和度(SPO2)、呼吸频率(RR),麻醉深度(BIS)并记录恶心呕吐、体动次数、呼吸抑制以及术后苏醒延迟等不良事件以及用药情况。结果:两组患者均完成手术,A组仅T4的平均动脉压较T0显著降低(P小于0.05);B组T2、T3、T4的平均动脉压较T0均显著降低(P小于0.05)。两组在心率方面各时间点的变化无统计学意义。B组T1、T2的血氧饱和度较其T0及A组T1、T2均显著降低。A组在手术过程中的呛咳次数、体动次数、呼吸抑制、都较B组明显少((P小于0.05),但其恶心呕吐发生率较B组高(P小于0.05)。结论:盐酸羟考酮联合丙泊酚和右美托咪啶的非气管插管静脉全身麻醉方法可安全用于门诊日间肝癌射频治疗手术中,能够满足术中镇静镇痛的需求,患者和外科医生均感满意。

Objective:To compare the effect and safety of general anesthesia between Oxycodone Hydrochloride and Fentanyl in the hepatoma patient’s radiofrequency ablate treatment.Methods:80ASA Ⅰ-Ⅲpatients undergoing elective radiofrequency ablate operation were randomly divided into A and B groups.Group A was intravenous general anaesthetized without tracheal intubation by Oxycodone Hydrochloride combined with Propofol and Dexmedetomidine Pyridine;Group B was intravenous general anaesthetized without tracheal intubation by Fentanyl combined with Propofol and Dexmedetomidine Pyridine.The mean arterial pressure(MAP)、heart rate(HR)、blood oxygen saturation(SPO2)、respiratory rate(RR)、depth of anesthesia(BIS)at the moment of entering room(T0)、5minutes after the durg were pumped(T1)、the starting of treatment(T2)、6minutes after the starting(T3)and the ending of treatment were monitored and recorded,the combined drug usage and adverse event as nausea and vomiting、body movement frequency、respiratory depression、postoperative delayed awakening were also recorded.Result:All procedures were completed successfully,the MAP at the moment of T4 was significantly lower than T0 in group A(P<0.05),the MAP at the moment of T2,T3,T4 were significantly lower than T0 in group A(P<0.05).No significant HR change was observed at each moment in two groups.The SPO2 at the moment of T1 and T2were significantly lower than T0 in group B and also lower than the moment of T1 and T2in group A.The irritating cough frequency、body movement frequency、respiratory depression during surgery in group A were significantly less than group B(P<0.05),but the incidence of nausea and vomiting in group A was higher than group B(P<0.05).Conclusion:The intravenous general anesthesia without tracheal intubation by Oxycodone Hydrochloride combined with Propofol and Dexmedetomidine Pyridine was safe for the radiofrequency ablate operation in outpatient,it can meet the needs of intraoperative sedation,both the patients and surgeons feel satisfied.