等效剂量地佐辛与瑞芬太尼对宫腔镜手术患者喉罩置入反应的半数有效血浆靶浓度的影响

Effects of equivalent doses of dezocine and remifentanil on half effective plasma target concentration of laryngeal mask insertion in patients with hysteroscopic surgery

摘要:

目的 探讨等效剂量地佐辛与瑞芬太尼对宫腔镜手术患者喉罩置入反应的半数有效血浆靶浓度（EC50）的影响。方法 选取2019年3月—2020年5月于南通市妇幼保健院全身麻醉下行宫腔镜手术患者126例，采用随机数字表法分为A、B、C组，每组42例。所有患者靶控输注丙泊酚，另A组给予生理盐水，B组给予血浆靶控浓度为0.50 μg/kg的瑞芬太尼，C组给予血浆靶控浓度为0.15 mg/kg的地佐辛。比较3组T₀（麻醉诱导前）、T₁（置入喉罩前1 min）、T₂（置入喉罩即刻）、T₃（置入喉罩后1 min）的平均动脉压和心率，比较3组喉罩置入反应的EC50、围手术期苏醒及苏醒期躁动情况，统计患者术后麻醉药物安全性。结果 3组T₀、T₁、T₂、T₃的平均动脉压比较结果：①不同时间点的平均动脉压有差异（P <0.05）；②3组的平均动脉压有差异（P <0.05），B组和C组T₂时刻的平均动脉压较A组高；③3组的平均动脉压变化趋势有差异（P <0.05）。3组T₀、T₁、T₂、T₃的心率比较结果：①不同时间点的心率有差异（P <0.05）；②3组的心率无差异（P >0.05）；③3组的心率变化趋势无差异（P >0.05）。3组术后苏醒时间、自主呼吸恢复时间、术后拔管时间比较，差异均无统计学意义（P >0.05）。C组苏醒期躁动发生率低于A组（P <0.0167）。3组总不良反应发生率比较，差异无统计学意义（P >0.05）。结论 靶控丙泊酚条件下，0.15 mg/kg地佐辛与瑞芬太尼均可抑制宫腔镜手术患者喉罩置入反应的EC50，且两者用于麻醉时患者血流动力学稳定，但地佐辛在降低患者苏醒期躁动发生风险方面具有一定优势。

Abstract:

Objective To investigate the effect of equivalent doses of dezocine and remifentanil on the median effective plasma target concentration (EC50) of laryngeal mask placement in patients undergoing hysteroscopic surgery.Methods From March 2019 to May 2020, 126 patients who underwent hysteroscopic surgery under general anesthesia in hospital were selected and divided into groups A, B, and C by random number table method, with 42 cases in each group. Each group was received target-controlled infusion of propofol. In addition, group A was given normal saline, group B was given remifentanil with a plasma target-controlled concentration of 0.50 μg/kg, and group C was given dezocine with a plasma target-controlled concentration of 0.15 mg/kg. The mean arterial pressure, heart rate at T₀ (before induction of anesthesia), T₁ (1 min before laryngeal mask placement), T₂ (when laryngeal mask placement), and T₃ (1 min after laryngeal mask placement) were compared among the three groups. EC50 of laryngeal mask insertion response, perioperative awakening and restlessness during awakening were compared among the three groups. Postoperative anesthesia drug safety of patients was counted.Results The mean arterial pressure at T₀, T₁, T₂, and T₃ in group A, B and C was compared, and the results showed that: The mean arterial pressure was different at different time points (P < 0.05); the mean arterial pressure was different in group A, group B, and group C (P < 0.05); the mean arterial pressure at T₂ was higher between group B and group C; the change trend of mean arterial pressure was different between group A, group B and group C (P < 0.05). The heart rate at T₀, T₁, T₂, and T₃ in groups A, B, and C were compared. The results showed that: the heart rate at different time points was different (P < 0.05); the heart rate in groups A, B, and C was not different (P > 0.05); the trend of mean arterial pressure in groups A, B, and C was not different (P > 0.05). The EC50 of groups B and C was lower than that of group A (P < 0.05). There were no significant differences in postoperative recovery time, spontaneous breathing recovery time, and postoperative extubation time among the three groups (P > 0.05). The incidence of agitation during recovery in group C was lower than groups A (P < 0.0167). There was no significant difference in the incidence of total adverse reactions among the three groups (P > 0.05).Conclusion Under the background of target-controlled propofol, both 0.15 mg/kg dezocine and remifentanil can inhibit the EC50 of laryngeal mask insertion reaction in patients with hysteroscopic surgery, and both are hemodynamically stable during anesthesia. However, dezocine has certain advantages in reducing the risk of agitation during recovery.