羟考酮在腹腔镜胆囊切除术麻醉诱导的适宜剂量探讨

Optimum dose of Oxycodone for anesthesia induction in patients undergoing laparoscopic cholecystectomy

摘要:

目的 探讨盐酸羟考酮用于腹腔镜胆囊切除术（LC）麻醉诱导的适宜剂量。方法 择期LC术患者90例，美国麻醉医师协会（ASA）分级Ⅰ或Ⅱ级，采用随机数字表法分为3组：不同剂量羟考酮组（O1～O3组）。麻醉诱导：静脉注射丙泊酚1.00～2.00?mg/kg、不同剂量羟考酮组（O1～O3组）分别静脉注射羟考酮0.20、0.30和0.40?mg/kg、维库溴铵0.10?mg/kg。麻醉维持采用常用的静吸复合药物。记录入手术室后（T0）、麻醉诱导置入喉罩后1?min（T1）、建立人工气腹后（T2）、分离胆囊时（T3）、苏醒即刻（T4）和离开复苏室即刻（T5）时的心率（HR）、收缩压（SBP）、舒张压（DBP），记录T4、T5、术后4 h（T6）和术后8?h（T7）的疼痛数字等级评分（NRS），记录患者术中使用瑞芬太尼总量，围术期羟考酮总量。记录苏醒时间及术毕患者复苏过程中追加止痛药例数，观察术后患者不良反应情况。结果 O2和O3组患者术中平均HR、SBP及DBP波动不超过基础值的20.00%。3组患者术毕苏醒时间无明显差异。O1组苏醒后主诉NRS>4分要求再追加止痛药的患者为22例，O2组为7例，O3组为3例，3组间差异有统计学意义。3组患者围术期羟考酮总消耗量为O1组：（18.93±4.34）mg（0.90～2.60?mg）；O2组：（25.50±4.49）mg（1.40～3.00?mg）；O3组：（26.10±4.55）mg（1.80～3.40?mg），O1组较O2及O3组消耗量更少（F?=23.79，P?=0.000）。3组患者不良反应情况比较差异无统计学意义，但是O3组患者有1例出现呼吸抑制的严重不良反应。结论 羟考酮用于LC手术麻醉诱导的适宜剂量为0.30 mg/kg。

Abstract:

Objective To determine the optimum dose of Oxycodone for anesthesia induction in patients undergoing laparoscopic cholecystectomy. Methods Ninety patients, ASAⅠorⅡ, scheduled for elective LC, were randomly divided into 3 groups using random number table (O 1~O 3 groups, n = 30 each). Anesthesia was induced with iv Propofol 1.00~2.00?mg/kg, Oxycodone 0.20?mg/kg, 0.3?mg/kg and 0.4?mg/kg (O 1~O 3 groups, respectively), and Vecuronium 0.10 mg/kg. Before anesthesia induction (?T0?), 1 min after Laryngeal Mask intubating (?T1?), the instant of pneumoperitoneum (?T2?), separation of the gallbladder (?T3?), wake up immediately (?T4??), leaving the recovery room (?T5?), the heart rate (HR), systolic blood pressure (SBP) and diastolic blood pressure (DBP) were recorded. At T4, leaving the recovery room (?T5?), 4 hours after the operation (?T6?), 8 hours after operation (T7), the numeric pain rating scale (NRS) were recorded. The overall amount of remifentanil and Oxycodone were record. The wake up time, additional analgetic cases and the adverse reactions were recorded. Results The average HR, SBP and DBP fluctuations in the O 2 and O 3 groups were not more than 20.00% of the basal values. There was no significant difference in wake up time between the three groups. There were 22 cases of patients, the NRS >?4, in O1 group requires additional analgesics after they wake up, more than O 2 and O 3 group (7, 3 respectively, P?