喉罩通气下不同剂量羟考酮诱导对 腹腔镜胆囊切除术的影响

Influences of different doses of oxycodone hydrochloride in the induction for laryngeal mask airway in patients undergoing laparoscopic cholecystectomy

摘要:

目的 探讨不同剂量的羟考酮诱导喉罩置入腹腔镜胆囊切除术（LC）中的临床效果。方法 选取 2017 年1 月—2017 年6 月大连大学附属中山医院行LC 手术患者80 例，采用随机数字表法分为4 组，每组20 例。 不同剂量的羟考酮组（O1、O2 及O3）分别静脉注射羟考酮0.10、0.15 和0.25 mg/kg，依托咪酯0.3 mg/kg 和罗库溴铵0.6 mg/kg 诱导喉罩置入后行机械通气，对照组（C）将羟考酮换成舒芬太尼0.25μg/kg， 其他相同。术中静脉泵注丙泊酚50 ～ 150μg/（kg·min）和瑞芬太尼0.1 ～ 0.3μg/（kg·min）维持麻醉， 调控泵速维持脑电双频指数（BIS）值40 ～ 60。记录4 组患者手术时间、苏醒时间、拔喉罩时间，以及丙泊 酚和瑞芬太尼用量。比较4 组患者入室（T0）、插喉罩前（T1）、插喉罩后1 min（T2）、气腹时（T3）及切胆 时（T4）平均血压（MBP）和心率（HR）的变化。评估4 组患者拔喉罩后5 min（T5），1 h（T6），4 h（T7）， 8 h（T8）及12 h（T9）的疼痛视觉模拟量表评分（VAS），以及对镇痛药的需求情况。记录呛咳、恶心呕吐、 头晕、嗜睡及高血压的发生情况。结果 4 组患者T1 时血压、心率低于T0（P <0.05），T2 时O1 组血压高于C、 O2 和O3 组（P<0.05），T3 时O1 组和C 组血压高于O2 和O3 组（P <0.05）；O1 组在T5、T6，O2 组和O3 组在 T5、T8 时VAS 评分低于C 组（P <0.05）；O2 组和O3 组在T5、T8 时VAS 评分低于O1 组（P <0.05）；O3 组 在T5、T6 时VAS 评分低于O2 组（P <0.05）；O1 组、O2 组和O3 组诱导期呛咳反应、术后曲马多使用低于C 组，O3 组术后曲马多使用低于O1 组和O2 组（P <0.05）；O2 组和O3 组术中高血压低于O1 组和C 组（P <0.05）。 结论 0.25 mg/kg 羟考酮可以安全有效地应用于喉罩LC 手术的全身麻醉诱导，既有利于术中血流动力学稳 定和术后镇痛，又不影响术后苏醒。

Abstract:

Objective To investigate the effects of different doses of oxycodone hydrochloride in the induction for general anesthesia of laryngeal mask airway in patients undergoing laparoscopic cholecystectomy (LC). Methods Totally eighty adult patients aged 25-65 years, ASA I or II, scheduled for elective LC, were randomly divided into 4 groups (n = 20): 3 different doses of oxycodone groups (O1, O2 and O3) and controlled group (C). Anesthesia was induced with intravenous oxycodone 0.10, 0.15 and 0.25 mg/kg (O1, O2 and O3, respectively) or sufentanil 0.25μg/kg (C), etomidate 0.3 mg/kg and rocuronium 0.6 mg/kg. Laryngeal mask was used to build artificial airway and ventilate patients mechanically after induction. Anesthesia was maintained with propofol 50-150μg/(kg?min) and remifentanil 0.1-0.3μg/(kg?min), according to change of BIS value among 40-60. The time of operation, recovery from anesthesia and extubation, the consumptions of propofol and remifentanil were recorded. The MBP and HR were compared with each other at different time points: entering the operating room (T0), before intubation (T1), one minute after intubation (T2), pneumoperitoneum (T3) and removal of the gallbladder (T4). Visual analogue scale (VAS) scores were evaluated at different time points: 5 min (T5), 1 h (T6), 4 h (T7), 8 h (T8) and 12 h (T9) after extubation. The postoperative requirements of analgesic and the occurrences of side-effects (bucking, nausea, vomiting, dizzy, drowsiness and hypertension) were also recorded. Results MBP and HR were significantly lower at T1 than that at T0 in 4 groups (P < 0.05). MBP was higher at T2 in group O1 than that in the other groups (P < 0.05), higher at T3 in groups O1 and C than that in groups O2 and O3 (P < 0.05). Compared with group C, VAS was significantly lower in group O1 from T5 to T6 and so did that in groups O2 and O3 from T5 to T8 (P < 0.05). Compared with group O1, VAS was also significantly lower in groups O2 and O3 from T5 to T8 (P < 0.05), and so did that in group O3 than that in group O2 from T5 to T6 (P < 0.05). The incidence of bucking during induction and the postoperative requirements of tramadol were significantly lower in group C than those in group O1, O2 and O3 (P < 0.05). The postoperative requirements of tramadol was lower in group O3 than those in groups O1 and O2 (P < 0.05). The incidence of hypertension was lower in groups O2 and O3 than that in groups O1 and C (P < 0.05). Conclusions Using 0.25 mg/kg oxycodone hydrochloride in the induction of general anesthesia with laryngeal mask airway in LC is safe and efficient. It is beneficial for both intraoperative hemodynamic stability and postoperative analgesia without affecting postoperative recovery.